Stent-assisted reconstructive endovascular repair of intracranial aneurysms: long-term clinical and angiographic follow-up

Abstract Background and Purpose: The development of self-expanding stents dedicated to intracranial use has significantly widened the applicability of endovascular therapy to many intracranial aneurysms. The purpose of this study was to report the angiographic and clinical outcomes of wide-necked intracranial aneurysms treated with stent. Methods: Between January 2007 and October 2011 we deployed 22 stents in 20 patients with wide-necked cerebral aneurysms. Inclusion criteria restricted the group to adult patients with wide-necked intracranial aneurysms (ruptured and unruptured lesions). Immediate post-procedural angiographic studies were performed to evaluate successful occlusion of the aneurysm as well as patency of the parent vessel. We assessed long term angiography follow-up to detect in-stent stenosis, progressive thrombosis, recurrence and need for retreatment. Clinical outcome was assessed with the modifing Ranking Scale (mRS). Results: Technical success was obtained in all 22 (100%) cases. Angiography immediately after treatment procedure showed complete occlusion in 7 aneurysms (35%), neck remnant in 11 (55%), incomplete occlusion in 1 (5%) and partial occlusion in 1 (5%). During the endovascular embolization procedure no rupture of the sac or bleeding complication occurred; none of the patients needed undergoing surgical crossover. Procedure-related adverse events occurred in one (5%) patient: a brachial artery pseudoaneurysm. Three (15%) patients had neurological complications after procedure, whose 1 (5%) transitory complication spontaneusly resolved. Two patients (10%), had acute complete in-stent thrombosis which resolved after intraarterial administration of abciximab and placement of a new stent in-stent. Of the 20 patients treated with stent deployment, a follow-up imaging study was available in all 19 surviving patients (95%) at an average of 16.2 months (range, 6 to 50 months). The first follow-up DSA, compared with initial angiography, showed no changes in 14 aneurysms (73.7%), progressive thrombosis in 3 (15.7%), and major recurrence in 2 (10.5%). The overall rate of succesful procedure to 6 months is 89.5%; there was 1 case of asintomatic moderate endothelial hyperplasia. The further follow-up imaging study, showed no changes in 17 (89.5%) of the 19 surviving patients, 1 progressive thrombosis and 1 minor recurrence. One month- and long term (average of 16.2 months; range, 6 to 50 months) clinical follow-up showed no worsening in the mRS in 18 (90%) of 20 patients, 1 (5%) mRS 2 and 1 (5%) mRS 6. All the survived patients are alive and we did not observe periprocedural or long-term intracranial bleeding events or symptomatic stent related stenosis/occlusion complication. Conclusions: Our findings suggest that the endovascular treatment of intracranial aneurysms by stenting is feasible, effective and safe; follow-up results proved intact parent arteries and stable occlusion rates in the majority of treated aneurysms. Nevertheless, long-term data on safety and efficacy and larger patient groups are necessary