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Long-term Radiographic Results of Stent-Assisted Embolization of Cerebral Aneurysms

Lopes, Demetrius Klee MD; Johnson, Andrew Kelly MD; Kellogg, Robert Givens MD; Heiferman, Daniel Mark MD; Keigher, Kiffon Marie APN

Neurosurgery:
doi: 10.1227/NEU.0000000000000263
Research-Human-Clinical Studies
Abstract

BACKGROUND: Aneurysmal subarachnoid hemorrhage is a disabling disease. Endovascular coiling provides minimally invasive, effective, and safe treatment of both ruptured and unruptured intracranial aneurysms. Intracranial stents have improved the endovascular treatment of complex aneurysms, but the long-term durability of this treatment modality needs clarification.

OBJECTIVE: To elucidate the long-term success of intracranial stent use in the treatment of aneurysms.

METHODS: Four hundred ten patients were treated with stent-assisted endovascular management of 464 aneurysms. Treatment of 363 small aneurysms, 88 large aneurysms, and 13 giant aneurysms was analyzed with respect to both long-term anatomic results with digital subtraction angiography and magnetic resonance angiography over the follow-up period.

RESULTS: The 6-month angiographic results of 387 aneurysm treatments revealed complete aneurysm occlusion in 282 (72.9%), residual aneurysm neck in 50 (12.9%), and residual aneurysm filling in 55 (14.2%). Long-term radiographic follow-up, performed in 262 patients (mean, 3.63 years), showed significant recurrence of only 3 aneurysms after 6-month follow-up imaging. Forty-eight aneurysms (11.9%) were considered radiographic failures during the follow-up period.

CONCLUSION: The aneurysm recurrence rate after stent-assisted embolization in this series was similar to published data using only coil embolization for the period between treatment and the initial follow-up imaging. For aneurysms that do not initially recur, the presented data suggest improved durability in the subsequent long-term follow-up period.

ABBREVIATIONS: DSA, digital subtraction angiography

MRA, magnetic resonance angiography

Author Information

Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois

Correspondence: Demetrius K. Lopes, MD, 1725 W Harrison St, Ste 855, Chicago, IL 60612. E-mail: brainaneurysm@mac.com

Received June 25, 2013

Accepted November 25, 2013

Copyright © by the Congress of Neurological Surgeons