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Stenting as Monotherapy for Uncoilable Intracranial Aneurysms

Bulsara, Ketan R. MD*; Kuzmik, Gregory A. MD*; Hebert, Ryan MD*; Cheung, Vincent MD; Matouk, Charles C. MD*; Jabbour, Pascal MD§; Hasan, David MD; Pepper, Joshua MBBS*

Neurosurgery:
doi: 10.1227/NEU.0b013e31827fcaba
Technique Assessment
Abstract

BACKGROUND: Small, blister-like aneurysms (BLAs), by virtue of their unique morphology, are difficult to treat with conventional modalities. The use of oversized self-expanding stents as monotherapy for BLAs is a relatively new and promising concept that warrants further investigation.

OBJECTIVE: To clarify the role of oversized self-expanding stents as monotherapy for BLAs.

METHODS: Five consecutive patients were treated for BLAs with oversized self-expanding stents alone by the senior author (K.R.B.). We report on their clinical and radiographic outcomes.

RESULTS: All 5 patients in our series were discharged in good clinical condition. Complete aneurysm occlusion was observed in all patients at the time of most recent radiographic follow-up. Mean follow-up time was 13.6 months (range, 1 month to 4.5 years).

CONCLUSION: The use of oversized self-expanding stents to redirect flow away from aneurysms is an effective option for patients with BLAs. This approach represents an alternative to the use of flow diverters.

ABBREVIATIONS: BLA, blister-like aneurysm

CTA, computed tomography angiogram

ICA, internal carotid artery

SAH, subarachnoid hemorrhage

Author Information

*Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut;

Division of Neurosurgery, University of California, San Diego, California;

§Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;

Department of Neurosurgery, College of Medicine, University of Iowa, Iowa City, Iowa

Correspondence: Ketan R. Bulsara, MD, Yale Department of Neurosurgery, 333 Cedar St, TMP 4, New Haven, CT 06520. E-mail: ketan.bulsara@yale.edu

Received August 5, 2012

Accepted November 26, 2012

Copyright © by the Congress of Neurological Surgeons