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Erschienen in: Neuroradiology 12/2007

01.12.2007 | Interventional Neuroradiology

Treatment of wide-necked intracranial aneurysms with a novel self-expanding two-zonal endovascular stent device

verfasst von: Frank Ahlhelm, Christian Roth, Ralf Kaufmann, Gernot Schulte-Altedorneburg, Bernd F. M. Romeike, Wolfgang Reith

Erschienen in: Neuroradiology | Ausgabe 12/2007

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Abstract

Introduction

Endovascular treatment of intracerebral wide-necked aneurysms carries the risk of incomplete embolisation and recanalisation of the aneurysm as well as coil protrusion into the parent artery and embolic complications. We present preliminary results with the placement of a novel tightly braided stent across the aneurysm neck which might lead to thrombosis of these aneurysms.

Methods

A bifurcation artery aneurysm was created in a male New Zealand White Rabbit. After 4 weeks, a novel highly flexible stent with a central tightly braided mesh was placed across the aneurysm neck. Diagnostic angiography was performed during the procedure and immediately after stent deployment as well as 2 and 4 weeks following stent placement. Histological analyses, including microscopic investigations for evaluating intra-aneurysmal thrombosis and proliferation of the intima, were performed after 1 month.

Results

Intra-aneurysmal flow reduction due to stent placement was achieved as early as 45 min after deployment. Unchanged complete occlusion of the aneurysm could be observed by angiography 2 and 4 weeks post-stent deployment. Histological analysis confirmed angiographical findings of complete aneurysm occlusion and excluded significant neointimal coverage.

Conclusion

This newly designed flexible stent may offer the potential to expand endovascular treatment of wide-necked intracranial aneurysms.
Literatur
1.
Zurück zum Zitat Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817PubMedCrossRef Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817PubMedCrossRef
2.
Zurück zum Zitat Hayakawa M, Murayama Y, Duckwiler GR, Gobin YP, Guglielmi G, Vinuela F (2000) Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system. J Neurosurg 93:561–568PubMed Hayakawa M, Murayama Y, Duckwiler GR, Gobin YP, Guglielmi G, Vinuela F (2000) Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system. J Neurosurg 93:561–568PubMed
3.
Zurück zum Zitat Kole MK, Pelz DM, Kalapos P, Lee DH, Gulka IB, Lownie SP (2005) Endovascular coil embolization of intracranial aneurysms: important factors related to rates and outcomes of incomplete occlusion. J Neurosurg 102:607–615PubMed Kole MK, Pelz DM, Kalapos P, Lee DH, Gulka IB, Lownie SP (2005) Endovascular coil embolization of intracranial aneurysms: important factors related to rates and outcomes of incomplete occlusion. J Neurosurg 102:607–615PubMed
4.
Zurück zum Zitat Fernandez Zubillaga A, Guglielmi G, Vinuela F, Duckwiler GR (1994) Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. Am J Neuroradiol 15:815–820PubMed Fernandez Zubillaga A, Guglielmi G, Vinuela F, Duckwiler GR (1994) Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. Am J Neuroradiol 15:815–820PubMed
5.
Zurück zum Zitat Casasco AE, Aymard A, Gobin YP Houdart E, Rogopoulos A, George B, Hodes JE, Cophignon J, Merland JJ (1993) Selective endovascular treatment of 71 intracranial aneurysms with platinum coils. J Neurosurg 79:3–10PubMed Casasco AE, Aymard A, Gobin YP Houdart E, Rogopoulos A, George B, Hodes JE, Cophignon J, Merland JJ (1993) Selective endovascular treatment of 71 intracranial aneurysms with platinum coils. J Neurosurg 79:3–10PubMed
6.
Zurück zum Zitat Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, Moret J (1999) Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212:348–356PubMed Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, Moret J (1999) Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212:348–356PubMed
7.
Zurück zum Zitat Lefkowitz MA, Gobin YP, Akiba Y, Duckwiler GR, Murayama Y, Guglielmi G, Martin NA, Vinuela F (1999) Ballon-assisted Guglielmi detachable coiling of wide-necked aneurysm: Part II-clinical results. Neurosurgery 45:531–537PubMedCrossRef Lefkowitz MA, Gobin YP, Akiba Y, Duckwiler GR, Murayama Y, Guglielmi G, Martin NA, Vinuela F (1999) Ballon-assisted Guglielmi detachable coiling of wide-necked aneurysm: Part II-clinical results. Neurosurgery 45:531–537PubMedCrossRef
8.
Zurück zum Zitat Pelz DM, Lownie SP, Fox AJ (1998) Thromboembolic events associated with the treatment of cerebral aneurysms with Guglielmi detachable coils. Am J Neuroradiol 19:1541–1547PubMed Pelz DM, Lownie SP, Fox AJ (1998) Thromboembolic events associated with the treatment of cerebral aneurysms with Guglielmi detachable coils. Am J Neuroradiol 19:1541–1547PubMed
9.
Zurück zum Zitat Moret J, Cognard C, Weill A, Castaings L, Rey A (1997) Reconstruction technique in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases. J Neuroradiol 24:30–44PubMed Moret J, Cognard C, Weill A, Castaings L, Rey A (1997) Reconstruction technique in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases. J Neuroradiol 24:30–44PubMed
10.
Zurück zum Zitat Wanke I, Doerfler A, Schoch B, Stolke D, Forsting M (2003) Treatment of wide-necked intracranial aneurysms with a self-expanding stent system: initial clinical experience. Am J Neuroradiol 241192–1199PubMed Wanke I, Doerfler A, Schoch B, Stolke D, Forsting M (2003) Treatment of wide-necked intracranial aneurysms with a self-expanding stent system: initial clinical experience. Am J Neuroradiol 241192–1199PubMed
11.
Zurück zum Zitat Zenteno M, Modenesi Freitas JM, Aburto-Murrieta Y, Aburto-Murrieta Y, Koppe G, Machado E, Lee A (2006) Balloon-expandable stenting with and without coiling for wide-neck and complex aneurysms. Surg Neurol 66:603–610PubMedCrossRef Zenteno M, Modenesi Freitas JM, Aburto-Murrieta Y, Aburto-Murrieta Y, Koppe G, Machado E, Lee A (2006) Balloon-expandable stenting with and without coiling for wide-neck and complex aneurysms. Surg Neurol 66:603–610PubMedCrossRef
12.
Zurück zum Zitat Grunwald IQ, Romeike BF, Roth C, Struffert T, Eymann R, Reith W (2005) Anticoagulation regimes and their influence on the occlusion rate of aneurysms: an experimental study in rabbits. Neurosurgery 57:1048–1055PubMedCrossRef Grunwald IQ, Romeike BF, Roth C, Struffert T, Eymann R, Reith W (2005) Anticoagulation regimes and their influence on the occlusion rate of aneurysms: an experimental study in rabbits. Neurosurgery 57:1048–1055PubMedCrossRef
13.
Zurück zum Zitat Romeike BF, Feiden W (1998) Demonstration of platinum microcoils in embolized blood vessels in-situ using a modified methyl methacrylate embedding method, and a special cutting and grinding technique. Biotech Histochem 73:198–201PubMed Romeike BF, Feiden W (1998) Demonstration of platinum microcoils in embolized blood vessels in-situ using a modified methyl methacrylate embedding method, and a special cutting and grinding technique. Biotech Histochem 73:198–201PubMed
14.
Zurück zum Zitat Lieber BB, Gounis MJ (2002) The physics of endoluminal stenting in the treatment of cerebrovascular aneurysms. Neurol Res 24[Suppl 1]:33–42CrossRef Lieber BB, Gounis MJ (2002) The physics of endoluminal stenting in the treatment of cerebrovascular aneurysms. Neurol Res 24[Suppl 1]:33–42CrossRef
15.
Zurück zum Zitat Hirabayashi M, Ohta M, Rufenacht DA, Chopard B (2003) Characterization of flow reduction properties in an aneurysm due to a stent. Phys Rev E Stat Nonlin Soft Matter Phys 68:021918PubMed Hirabayashi M, Ohta M, Rufenacht DA, Chopard B (2003) Characterization of flow reduction properties in an aneurysm due to a stent. Phys Rev E Stat Nonlin Soft Matter Phys 68:021918PubMed
16.
Zurück zum Zitat Baráth K, Cassot F, Fasel JH, Ohta M, Rüfenacht DA (2005) Influence of stent properties on the alteration of cerebral intra-aneurysmal haemodynamics: flow quantification in elastic sidewall aneurysm models. Neurol Res 27[Suppl 1]:120–128CrossRef Baráth K, Cassot F, Fasel JH, Ohta M, Rüfenacht DA (2005) Influence of stent properties on the alteration of cerebral intra-aneurysmal haemodynamics: flow quantification in elastic sidewall aneurysm models. Neurol Res 27[Suppl 1]:120–128CrossRef
17.
Zurück zum Zitat Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C (2002) Endovascular reconstruction of intracranial arteries by stent placement and combined techniques. J Neurosurg 97:1306–1313PubMed Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C (2002) Endovascular reconstruction of intracranial arteries by stent placement and combined techniques. J Neurosurg 97:1306–1313PubMed
18.
Zurück zum Zitat Vanninen R, Manninen H, Ronkainen A (2003) Broad-based intracranial aneurysms: thrombosis induced by stent placement. Am J Neurorad 24:263–266 Vanninen R, Manninen H, Ronkainen A (2003) Broad-based intracranial aneurysms: thrombosis induced by stent placement. Am J Neurorad 24:263–266
19.
Zurück zum Zitat Fiorella D, Albuquerque FC, Deshmukh VR, Woo HH, Rasmussen PA, Masaryk TJ, McDougall CG (2006) Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysms. Neurosurgery 59:291–300PubMedCrossRef Fiorella D, Albuquerque FC, Deshmukh VR, Woo HH, Rasmussen PA, Masaryk TJ, McDougall CG (2006) Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysms. Neurosurgery 59:291–300PubMedCrossRef
20.
Zurück zum Zitat Ansari SA, Lassig JP, Nicol E, Thompson BG, Gemmete JJ, Gandhi D (2007) Thrombosis of a fusiform intracranial aneurysm induced by overlapping neuroform stents: case report. Neurosurgery 60:E950–E951PubMedCrossRef Ansari SA, Lassig JP, Nicol E, Thompson BG, Gemmete JJ, Gandhi D (2007) Thrombosis of a fusiform intracranial aneurysm induced by overlapping neuroform stents: case report. Neurosurgery 60:E950–E951PubMedCrossRef
21.
Zurück zum Zitat Lanzino G, Wakhloo AK, Fessler RD, Hartney ML, Guterman LR, Hopkins LN (1999) Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg 91:538–546PubMed Lanzino G, Wakhloo AK, Fessler RD, Hartney ML, Guterman LR, Hopkins LN (1999) Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg 91:538–546PubMed
22.
Zurück zum Zitat Fiorella D, Albuquerque FC, Masaryk TJ, Rasmussen PA, McDougall CG (2005) Balloon-in-stent technique for the constructive endovascular treatment of “ultra-wide necked” circumferential aneurysms. Neurosurgery 57:1218–1227PubMedCrossRef Fiorella D, Albuquerque FC, Masaryk TJ, Rasmussen PA, McDougall CG (2005) Balloon-in-stent technique for the constructive endovascular treatment of “ultra-wide necked” circumferential aneurysms. Neurosurgery 57:1218–1227PubMedCrossRef
23.
Zurück zum Zitat Doerfler A, Wanke I, Egelhof T, Stolke D, Forsting M (2004) Double-stent method: therapeutic alternative for small wide-necked aneurysms. Technical note. J Neurosurg 100:150–154PubMedCrossRef Doerfler A, Wanke I, Egelhof T, Stolke D, Forsting M (2004) Double-stent method: therapeutic alternative for small wide-necked aneurysms. Technical note. J Neurosurg 100:150–154PubMedCrossRef
Metadaten
Titel
Treatment of wide-necked intracranial aneurysms with a novel self-expanding two-zonal endovascular stent device
verfasst von
Frank Ahlhelm
Christian Roth
Ralf Kaufmann
Gernot Schulte-Altedorneburg
Bernd F. M. Romeike
Wolfgang Reith
Publikationsdatum
01.12.2007
Verlag
Springer-Verlag
Erschienen in
Neuroradiology / Ausgabe 12/2007
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-007-0281-6

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