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(Stroke. 2008;39:3288.)
© 2008 American Heart Association, Inc.

Original Contributions

Stent-Assisted Reconstructive Endovascular Repair of Cranial Fusiform Atherosclerotic and Dissecting Aneurysms

Long-Term Clinical and Angiographic Follow-Up

Ajay K. Wakhloo, MD, PhD; Jake Mandell, MD; Matthew J. Gounis, PhD; Christopher Brooks, PAC; Italo Linfante, MD; Jesse Winer, MD John P. Weaver, MD

From the Division of Neuroimaging and Intervention, Departments of Radiology and Neurosurgery, University of Massachusetts Medical School, Worcester, Mass.

Correspondence to Ajay K. Wakhloo, MD, PhD, Division of Neuroimaging and Intervention, Department of Radiology, University of Massachusetts, Memorial University Campus, 55 Lake Avenue North, Worcester, MA 01655. E-mail wakhlooa{at}ummhc.org

Background and Purpose— The purpose of this study was to investigate the periprocedural morbidity, mortality, and long-term clinical and angiographic follow-up using stent-assisted coiling and stenting alone for treatment of cranial fusiform dissecting and atherosclerotic aneurysms.

Methods— The Institutional Review Board approved the study. A retrospective analysis was performed of 30 fusiform dissecting and atherosclerotic aneurysms treated in 28 patients (20 females; mean age, 52.6 years). Eleven aneurysms (37%) were located in the posterior circulation. Twenty-one (70%) originated from arterial dissection and 4 aneurysms (13%) presented with subarachnoid bleeding. Twenty-four (80%) aneurysms were treated with stents and coils, whereas 6 (20%) were treated with stents alone.

Results— Immediate postprocedural angiograms in 24 aneurysms treated with stent-assisted coiling showed complete occlusion in 12 and subtotal occlusion in 11 aneurysms, whereas no occlusion was seen in one aneurysm and in all 6 aneurysms treated with stents alone. A clinical improvement or stable outcome was achieved in 25 patients (89%). The 2 cases of permanent morbidity included a patient with a finger dysesthesia associated with a perforator stroke and another patient with hemiparesis and aphasia due to a delayed in-stent thrombosis. One patient died after treatment of a giant vertebrobasilar junction aneurysm. Angiographic follow-up was available in 23 of the 27 surviving patients (85%) at a mean of 16.2 months (range, 1 to 108 months). Recanalization in 4 patients (17%) at 3, 5, 24, and 36 months required retreatment in 3. In-stent stenosis of 50% was found in 3 patients.

Conclusion— Stent-assisted coil embolization is an attractive option for ruptured and nonruptured fusiform aneurysms with stable long-term outcome. However, recanalization observed up to 3 years after the initial obliteration emphasizes the need for long-term follow-up angiography.

Key Words: dissecting aneurysm • fusiform aneurysms • intracranial aneurysms • new endovascular techniques • pseudoaneurysms • stent-assisted coiling • stents

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