Stenting and Secondary Coiling of Intracranial Internal Carotid Artery Aneurysm: Technical Case Report

Stenting and Secondary Coiling of Intracranial Internal Carotid Artery Aneurysm: Technical Case... AbstractOBJECTIVE AND IMPORTANCEEndovascular stents have been successfully used in the treatment o f fusiform and dissecting aneurysms of the peripheral circulation and extracranial carotid and vertebral arteries. Technical limitations related to the in a bility to navigate the stent and the delivery system through tortuous vascular segments has limited their application with intracranial lesions. Availability of new flexible and pliable stent systems might overcome these difficulties.CLINICAL PRESENTATIONA 49-year-old woman presented with a dissecting pseudoaneurysm of the horizontal portion of the petrous internal carotid artery that increased in size, as revealed by serial angiographic studies.INTERVENTIONThe aneurysm was treated by deploying a new flexible stent across the aneurysm neck and by then packing the aneurysm sac with Guglielmi detachable coils that were delivered by a microcatheter positioned through the stent struts into the aneurysm lumen.CONCLUSIONNew flexible stents can be used to treat intracranial internal carotid artery aneurysms in difficult-to-access areas, such as the horizontal petrous segment. The stent may disrupt the aneurysm inflow tract, thereby inducing stasis and facilitating intra-aneurysmal thrombosis. In addition, the stent acts as an endoluminal scaffold to prevent coil herniation into the parent artery, which allows tight packing of even widenecked and irregularly shaped aneurysms. The stent may also serve as a matrix for endothelial growth. We think this new generation of flexible stents and the use of this described technique will usher in the next era of endovascular management o f intracranial aneurysms. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Stenting and Secondary Coiling of Intracranial Internal Carotid Artery Aneurysm: Technical Case Report

Stenting and Secondary Coiling of Intracranial Internal Carotid Artery Aneurysm: Technical Case Report

Intracranial Carotid Aneurysm Stenting 1229 t e m h a s b e e n f o u n d to h a v e s i g n i f i c a n t Stenting and Secondary Coiling of l i m i t a t i o n s , e s p e c i a l l y f o r f u s i f o r m , d i s ­ s e c t i n g , o r w i d e - n e c k e d a n e u r y s m s (4, 6, Intracranial Internal Carotid Artery 8). O n e s o l u t i o n f o r t h e t r e a t m e n t o f w i d e - n e c k e d a n e u r y s m s is t e m p o r a r y Aneurysm: Technical Case Report b a l l o o n p r o t e c t i o n d u r i n g c o i l i n g to p r e ­ v e n t c o i l h e r n i a t i o n i n t o t h e p a r e n t a r ­ t e r y ( 1 5 , 2 4 , 2 5 ) . H o w e v e r , f o r m a n y o t h e r i n t r a c r a n i a l a n e u r y s m s , t h e r e is n o Robert A. Mericle, M .D., Giuseppe Lanzino, M.D., a d j u n c t t e c h n i q u e f o r s u c c e s s f u l G D C Ajay K. Wakhloo, M .D., Ph.D., Lee R. Guterman, Ph.D., M.D., t r e a t m e n t . N e w e r s t e n t t e c h n o l o g y m a y L. Nelson Hopkins, M .D. b e t h e s o l u t i o n f o r m a n y o f t h e s e d i f f i ­ c u l t p r o b l e m s , a n d s t e n t s h a v e a l r e a d y Department of Neurosurgery and Toshiba Stroke Research Center, School of M edicine and b e e n u s e d to s u c c e s s f u l l y t r e a t f u s i f o r m Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York a n d d i s s e c t i n g a n e u r y s m s in t h e p e r i p h ­ e r a l c i r c u l a t i o n (2, 13, 2 7 , 2 8 , 3 0 , 3 5 ) . T h e u s e o f s t e n t s in e x p e r i m e n t a l s a c c u l a r OBJECTIVE A N D IM P O R T A N C E : E ndovascular stents have been successfully a n e u r y s m m o d e l s h a s b e e n w e l l s t u d i e d used in the tre a tm e n t o f fu s ifo rm and d isse ctin g aneurysm s o f the p e rip h ­ (1, 5, 16, 17, 2 2 , 3 6 - 3 9 , 4 1 ) . T h e f i n d i n g s eral c irc u la tio n and e x tra c ra n ia l c a ro tid and v e rte b ra l a rte rie s. T e...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199811000-00130
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE AND IMPORTANCEEndovascular stents have been successfully used in the treatment o f fusiform and dissecting aneurysms of the peripheral circulation and extracranial carotid and vertebral arteries. Technical limitations related to the in a bility to navigate the stent and the delivery system through tortuous vascular segments has limited their application with intracranial lesions. Availability of new flexible and pliable stent systems might overcome these difficulties.CLINICAL PRESENTATIONA 49-year-old woman presented with a dissecting pseudoaneurysm of the horizontal portion of the petrous internal carotid artery that increased in size, as revealed by serial angiographic studies.INTERVENTIONThe aneurysm was treated by deploying a new flexible stent across the aneurysm neck and by then packing the aneurysm sac with Guglielmi detachable coils that were delivered by a microcatheter positioned through the stent struts into the aneurysm lumen.CONCLUSIONNew flexible stents can be used to treat intracranial internal carotid artery aneurysms in difficult-to-access areas, such as the horizontal petrous segment. The stent may disrupt the aneurysm inflow tract, thereby inducing stasis and facilitating intra-aneurysmal thrombosis. In addition, the stent acts as an endoluminal scaffold to prevent coil herniation into the parent artery, which allows tight packing of even widenecked and irregularly shaped aneurysms. The stent may also serve as a matrix for endothelial growth. We think this new generation of flexible stents and the use of this described technique will usher in the next era of endovascular management o f intracranial aneurysms.

Journal

NeurosurgeryOxford University Press

Published: Nov 1, 1998

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