Stent-assisted embolization of internal carotid artery aneurysms.

摘要

BACKGROUND: Endovascular embolization of wide neck aneurysm often results in incomplete occlusion or aneurysm recurrence. The purpose of this study is to assess the efficacy and safety of stent-assisted embolization of wide neck aneurysms of the internal carotid artery (ICA). METHODS: A series of 10 patients with ICA aneurysms attempted treatment by stent-assisted Guglielmi detachable coil (GDC) embolization (n = 9) or by stent alone (n = 1). There were 3 men and 7 women ranging in age from 21 to 78 years, with a mean of 51 years. The indications of stenting were wide neck aneurysms (n = 9) and herniation of detached coils from aneurysmal sac into parent artery (n = 1). RESULTS: Endovascular stent placement was technically successful in 8 cases. In one case with a cervical big ICA aneurysm, a stent was placed across the neck of aneurysm without deposition of embolic material into the aneurysmal sac. The initial control angiogram revealed residual aneurysm; however, complete obliteration of aneurysmal sac was achieved as observed on angiograms in 8 months. Six cases of wide neck aneurysms were successfully treated by stent-assisted GDC embolization. One case had prolapse of coil loops into parent artery after coils detached; the coil loops were successfully pushed back to aneurysm after stent placement. Two patients had difficulties to navigate the stents across the aneurysm necks because of tortuous parent arteries; in one of them, the stent partially covered the neck of aneurysm, which made the success of subsequent GDC embolization; in the other one, advancement of the stent to the targeted site was abortive, and the aneurysm was eventually loose packing. No significant procedure-related complication was found. One patient had asymptomatic dissection of the parent artery after stent placement. One patient had a transient ischemic attack and returned to normal baseline neurological conditions later. Clinical follow-up for these patients was 0.5 to 36 months, with a mean of 14 months. CONCLUSIONS: Stent-assisted embolization is a treatment of choice for wide neck aneurysms or for patient with herniation of coil loops to parent artery after coil detached. It was proven both safe and effective over a relatively long follow-up.