Intracranial Arterial Reconstruction with Stent Placement and Combined Techniques
Purpose: To report our experience with the use of intracranial stents in the treatment of intracranial aneurysms, atherosclerotic lesions and arterial dissections. Clinical Material and Methods: Between June 1996 and August 2000, 61 consecutive patients were selected and treated with intracranial stents. There were 37 male and 24 female patients with ages ranging from 3 to 73 years (mean age 50). Group 1 included 41 patients harboring 42 cerebral aneurysms (saccular, dissecting or fusiform). The most common presentation was subarachnoid hemorrhage in 20 patients (48.8%) and mass effect in 17 (41.4%). The most common locations were the distal VA in 10 cases (23.8%) and the cavernous ICA in 10 cases. Group 2 included 20 patients harboring atheromatose stenosis or arterial ischemic dissections. Mean stenosis varied from 70 to 95%. Results: Group 1: Of the 42 aneurysms treated with stents, 30 (71%) underwent combined endovascular stent implantation and endosaccular coil placement, in 11 cases at the same procedure, in 12 cases coiling was in a second procedure performed after stenting, and in 6 cases coiling preceded stenting. Complete occlusion was accomplished in all the cases. In 12 cases the strategy was stenting with no further coiling. Four aneurysms (33%), are completely occluded with this technique. Group 2: Nineteen (95%) were evaluated as having postoperative GOS 4–5 and improving the degree of stenosis to less than 50%. Good short–term clinical outcome (GOS 4 and 5) was achieved in 52 patients (85%). Conclusions: The technique of using a stent as a mechanical barrier to allow coil placement in the aneurysmal sac provides another treatment option for aneurysms not amenable for clipping or conventional GDC. Angioplasty and stenting of intracranial vessels keeps vessel patency and avoids recoiling of the plaque. Stenting reconstruction is a feasible and relatively safe procedure in trained hands.