Cerebrovascular Diseases

Original Paper

Endovascular Reconstruction with the Willis Covered Stent for the Treatment of Large or Giant Intracranial Aneurysms

Tan H.-Q. · Li M.-H. · Li Y.-D. · Fang C. · Wang J.-B. · Wang W. · Wang J. · Zhang P.-L. · Zhu Y.-Q.

Author affiliations

Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated People’s Hospital, Shanghai Jiao Tong University, Shanghai, China

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Cerebrovasc Dis 2011;31:154–162

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: April 20, 2010
Accepted: September 27, 2010
Published online: December 04, 2010
Issue release date: January 2011

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Abstract

Background: The purpose of this study was to evaluate the feasibility, safety and efficacy of endovascular treatment of large or giant intracranial aneurysms with the Willis covered stent. Methods: Nineteen patients, each with a large or giant intracranial aneurysm, were treated with the Willis covered stent. Of these 19 aneurysms, 6 were giant and 13 were large; 18 were located in the cranial internal carotid artery and 1 in the vertebral artery. Results of the procedure, technical events and complications were recorded. Clinical and imaging follow-ups were performed at 3 and 6–12 months after the procedure. Results: Placement of Willis covered stent was successful in all patients. Complete aneurysm exclusion was achieved in 13 of the 19 aneurysms immediately after the procedure. No mortality or morbidity developed during the treatment or the follow-up period. During the follow-up period, complete aneurysm exclusion was achieved in 18 of the 19 patients; 11 aneurysms were totally involuted, 3 decreased to 25% of the original diameter, 4 decreased to 50% and 1 remained unchanged. Nine patients experienced full recovery, 9 improved and 1 was unchanged. No obvious in-stent stenosis was noted. Conclusions: Endovascular treatment of large or giant intracranial aneurysm with the Willis covered stent is feasible, safe and efficacious in selected cases. Endoleak is a frequent issue after initial covered stent placement, but can be eliminated or dramatically reduced to minimal endoleak by additional covered stent placement and/or balloon reinflation. Minor endoleak is likely to spontaneously resolve over time.

© 2010 S. Karger AG, Basel




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References

  1. Rinkel GJE, Djibuti M, Algra A, van Gijn J: Prevalence and risk of rupture of intracranial aneurysms – a systematic review. Stroke 1998;29:251–256.
  2. Wiebers D, Whisnant JP, Huston J, et al: Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362:103–110.
  3. Komotar RJ, Mocco J, Solomon RA: Guidelines for the surgical treatment of unruptured intracranial aneurysms: the First Annual J. Lawrence Pool Memorial Research Symposium – controversies in the management of cerebral aneurysms. Neurosurgery 2008;62:183–193; discussion 93–94.
  4. Lawton MT, Spetzler RF: Surgical management of giant intracranial aneurysms: experience with 171 patients. Clin Neurosurg 1995;42:245–266.
  5. Piepgras DG, Khurana VG, Whisnant JP: Ruptured giant intracranial aneurysms. II. A retrospective analysis of timing and outcome of surgical treatment. J Neurosurg 1998;88:430–435.
  6. Raaymakers TW, Rinkel GJ, Limburg M, Algra A: Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis. Stroke 1998;29:1531–1538.
  7. Kattner KA, Bailes J, Fukushima T: Direct surgical management of large bulbous and giant aneurysms involving the paraclinoid segment of the internal carotid artery: report of 29 cases. Surg Neurol 1998;49:471–480.
  8. Jafar JJ, Russell SM, Woo HH: Treatment of giant intracranial aneurysms with saphenous vein extracranial-to-intracranial bypass grafting: indications, operative technique, and results in 29 patients. Neurosurgery 2002;51:138–144; discussion 44–46.
  9. Parkinson RJ, Eddleman CS, Batjer HH, Bendok BR: Giant intracranial aneurysms: endovascular challenges. Neurosurgery 2006;59:S103–S112; discussion S3–S13.
  10. de Gast AN, Sprengers ME, van Rooij WJ, Lavini C, Sluzewski M, Majoie CB: Midterm clinical and magnetic resonance imaging follow-up of large and giant carotid artery aneurysms after therapeutic carotid artery occlusion. Neurosurgery 2007;60:1025–1029; discussion 9–31.
  11. de Gast AN, Sprengers ME, van Rooij WJ, Lavini C, Sluzewski M, Majoie CB: Long-term 3T MR angiography follow-up after therapeutic occlusion of the internal carotid artery to detect possible de novo aneurysm formation. AJNR Am J Neuroradiol 2007;28:508–510.
  12. van Rooij WJ, Sluzewski M, Metz NH, et al: Carotid balloon occlusion for large and giant aneurysms: evaluation of a new test occlusion protocol. Neurosurgery 2000;47:116–121; discussion 22.
  13. Higashida RT, Halbach VV, Dowd C, et al: Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: results in 87 cases. J Neurosurg 1990;72:857–863.
  14. Linskey ME, Jungreis CA, Yonas H, et al: Stroke risk after abrupt internal carotid artery sacrifice: accuracy of preoperative assessment with balloon test occlusion and stable xenon-enhanced CT. AJNR Am J Neuroradiol 1994;15:829–843.
  15. Gonzalez N, Murayama Y, Nien YL, et al: Treatment of unruptured aneurysms with GDCs: clinical experience with 247 aneurysms. AJNR Am J Neuroradiol 2004;25:577–583.
  16. Hayakawa M, Murayama Y, Duckwiler GR, Gobin YP, Guglielmi G, Vinuela F: Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system. J Neurosurg 2000;93:561–568.
  17. Murayama Y, Nien YL, Duckwiler G, et al: Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 2003;98:959–966.
  18. Vinuela F, Duckwiler G, Mawad M: Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 1997;86:475–482.
  19. Sluzewski M, Menovsky T, van Rooij WJ, Wijnalda D: Coiling of very large or giant cerebral aneurysms: long-term clinical and serial angiographic results. AJNR Am J Neuroradiol 2003;24:257–262.
  20. Gruber A, Killer M, Bavinzski G, Richling B: Clinical and angiographic results of endosaccular coiling treatment of giant and very large intracranial aneurysms: a 7-year, single-center experience. Neurosurgery 1999;45:793–803; discussion 803–804.
  21. Lubicz B, Piotin M, Mounayer C, Spelle L, Moret J: Selective endovascular treatment of intracranial aneurysms with a liquid embolic: a single-center experience in 39 patients with 41 aneurysms. AJNR Am J Neuroradiol 2005;26:885–893.
  22. Molyneux AJ, Cekirge S, Saatci I, Gal G: Cerebral Aneurysm Multicenter European Onyx (CAMEO) trial: results of a prospective observational study in 20 European centers. AJNR Am J Neuroradiol 2004;25:39–51.
  23. Cekirge HS, Saatci I, Ozturk MH, et al: Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single-center experience. Neuroradiology 2006;48:113–126.
  24. Blasco J, Macho JM, Burrel M, Real MI, Romero M, Montana X: Endovascular treatment of a giant intracranial aneurysm with a stent-graft. J Vasc Interv Radiol 2004;15:1145–1149.
  25. Burbelko MA, Dzyak LA, Zorin NA, Grigoruk SP, Golyk VA: Stent-graft placement for wide-neck aneurysm of the vertebrobasilar junction. AJNR Am J Neuroradiol 2004;25:608–610.
  26. Chiaradio JC, Guzman L, Padilla L, Chiaradio MP: Intravascular graft stent treatment of a ruptured fusiform dissecting aneurysm of the intracranial vertebral artery: technical case report. Neurosurgery 2002;50:213–216; discussion 6–7.
  27. Islak C, Kocer N, Albayram S, Kizilkilic O, Uzma O, Cokyuksel O: Bare stent-graft technique: a new method of endoluminal vascular reconstruction for the treatment of giant and fusiform aneurysms. AJNR Am J Neuroradiol 2002;23:1589–1595.
  28. Magoufis GL, Vrachliotis TG, Stringaris KA: Covered stents to treat partial recanalization of onyx-occluded giant intracavernous carotid aneurysm. J Endovasc Ther 2004;11:742–746.
  29. Redekop G, Marotta T, Weill A: Treatment of traumatic aneurysms and arteriovenous fistulas of the skull base by using endovascular stents. J Neurosurg 2001;95:412–419.
  30. Saatci I, Cekirge HS, Ozturk MH, et al: Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with mid-term follow-up results. AJNR Am J Neuroradiol 2004;25:1742–1749.
  31. Li MH, Li YD, Fang C, et al: Endovascular treatment of giant or very large intracranial aneurysms with different modalities: an analysis of 20 cases. Neuroradiology 2007;49:819–828.
  32. Wang JB, Li MH, Fang C, et al: Endovascular treatment of giant intracranial aneurysms with Willis covered stents: technical case report. Neurosurgery 2008;62:E1176–E1177; discussion E7.
  33. Li MH, Li YD, Gao BL, et al: A new covered stent designed for intracranial vasculature: application in the management of pseudoaneurysms of the cranial internal carotid artery. AJNR Am J Neuroradiol 2007;28:1579–1585.
  34. Zhu YQ, Li MH, Fang C, et al: Application of the Willis covered stent in the treatment of aneurysm in the cisternal segment of the internal carotid artery: a pilot comparative study with midterm follow-up. J Endovasc Ther 2010;17:55–65.
  35. Li MH, Li YD, Tan HQ, Luo QY, Cheng YS: Treatment of distal internal carotid artery aneurysm with the Willis covered stent: a prospective pilot study. Radiology 2009;253:470–477.
  36. Salzmann DL, Yee DC, Roach DJ, Berman SS, Williams SK: Effects of balloon dilatation on ePTFE structural characteristics. J Biomed Mater Res 1997;36:498–507.
  37. Khurana VG, Piepgras DG, Whisnant JP: Ruptured giant intracranial aneurysms. I. A study of rebleeding. J Neurosurg 1998;88:425–429.
  38. Cutlip DE, Baim DS, Ho KK, et al: Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation 2001;103:1967–1971.
  39. Cadroy Y, Bossavy JP, Thalamas C, Sagnard L, Sakariassen K, Boneu B: Early potent antithrombotic effect with combined aspirin and a loading dose of clopidogrel on experimental arterial thrombogenesis in humans. Circulation 2000;101:2823–2828.
  40. Leon MB, Baim DS, Popma JJ, et al: A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med 1998;339:1665–1671.
  41. Saw J, Steinhubl SR, Berger PB, et al: Lack of adverse clopidogrel-atorvastatin clinical interaction from secondary analysis of a randomized, placebo-controlled clopidogrel trial. Circulation 2003;108:921–924.
  42. Dorhout Mees SM, van den Bergh WM, Algra A, Rinkel GJ: Antiplatelet therapy for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2007:CD006184.
  43. Siironen J, Juvela S, Varis J, et al: No effect of enoxaparin on outcome of aneurysmal subarachnoid hemorrhage: a randomized, double-blind, placebo-controlled clinical trial. J Neurosurg 2003;99:953–959.
  44. Stankovic G, Colombo A, Presbitero P, et al: Randomized evaluation of polytetrafluoroethylene-covered stent in saphenous vein grafts: the Randomized Evaluation of polytetrafluoroethylene COVERed stent in Saphenous vein grafts (RECOVERS) Trial. Circulation 2003;108:37–42.
  45. Krings T, Hans FJ, Moller-Hartmann W, et al: Treatment of experimentally induced aneurysms with stents. Neurosurgery 2005;56:1347–1359; discussion 60.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: April 20, 2010
Accepted: September 27, 2010
Published online: December 04, 2010
Issue release date: January 2011

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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