Stent placement in the endovascular treatment of intracranial aneurysms

To analyze the immediate and midterm angiographic and clinical results of stent placement in the endovascular treatment of intracranial cerebral aneurysms.

Out of 330 cerebral aneurysms treated by endovascular approach in our neurovascular centre, stents have been used in 18 patients. Twelve aneurysms (66.7%) were acutely ruptured, four (22.2%) were unruptured, two (11.1%) were recanalized after initial coiling. In three patients (16.7%) stent placement was used for revascularization of acute vessel thrombosis during coiling. Angiographic follow-up was obtained in 13 (72.2%) patients (mean 1.8 years, range 0.4-6.6) and clinical follow-up in 13 (72.2%) patients (mean 2.0 years, range 0.2-6.6).

Complete occlusion was achieved in eight (44.4%) patients, a neck-remnant remained in four (22.2%) and an incomplete occlusion in four (22.2%). In the two cases of previously treated aneurysms a neck-remnant remained after secondary stent-assisted coiling. In four cases thromboembolic events resulted in a transient procedure related morbidity. No permanent procedure related morbidity or mortality was observed. One case of an asymptomatic late in-stent stenosis occurred. On clinical followup modified Ranking Score was 0 in 3 patients (23.1%), 1 in 3 patients (23.1%) and 2-3 in 7 patients (53.9%). On angiographic follow-up recanalisation was observed in 5 (38.5% = 5/13) aneurysms.

Even in acutely ruptured aneurysms, stent assisted coiling can be a relatively effective and safe treatment for cerebral aneurysms. One asymptomatic in-stent stenosis occurred indicating that the risk rate of restenosis seems to be lower compared to stent deployment in atherosclerotic lesions, where restenosis rates up to 30% are described.