USING OF LOW-PROFILE STENTS IN THE ENDOVASCULAR TREATMENT OF COMPLEX ANEURYSMS OF THE BRAIN
https://doi.org/10.17650/1683-3295-2018-20-1-49-55
Abstract
Introduction. Improvement of the endovascular equipment expands the possibilities in the treatment of complex aneurysms of the brain. The use of low-profile stents allowed performing operations on complex distal aneurysms. This publication assesses the effectiveness and safety of such operations.
Materials and methods. In the department of vascular neurosurgery for the period from June 2014 to December 2016 using low-profile stent, 44 patients with 45 aneurysms of cerebral vessels were operated.
Results. 44 patients with 45 cerebral aneurysms performed 46 endovascular interventions. Most stents were implanted in the posterior circulation – 30 (65.2 %), in the anterior circulation – 16 (34.8 %) patients. Total occlusion (Raymond–Roy I) immediately after surgery was achieved in 35 (83.3 %), subtotal (Raymond–Roy II) – 7 (17.7 %). A favorable outcome of treatment was obtained in 44 (97.7 %). An unfavorable result was obtained in 1 (2.3 %) patient. There was no mortality.
Conclusion. The results obtained may indicate the presence of a minimum incidence of complications that does not exceed the risk of a natural course of the disease. The results of control angiograms in the long-term period demonstrated the stability of totally occluded aneurysms, a minimal percentage of recanalization, and an increase in the rate of occlusion subtotal embolization of aneurysms.About the Authors
V. S. Kiselev
Federal Neurosurgical Center, Ministry of Health of Russia
Russian Federation
132/1 Nemirovicha-Danchenko St., Novosibirsk 630087
Russian Federation
132/1 Nemirovicha-Danchenko St., Novosibirsk 630087
R. R. Gafurov
Federal Neurosurgical Center, Ministry of Health of Russia
Russian Federation
132/1 Nemirovicha-Danchenko St., Novosibirsk 630087
Russian Federation
132/1 Nemirovicha-Danchenko St., Novosibirsk 630087
A. O. Sosnov
Federal Neurosurgical Center, Ministry of Health of Russia
Russian Federation
132/1 Nemirovicha-Danchenko St., Novosibirsk 630087
Russian Federation
132/1 Nemirovicha-Danchenko St., Novosibirsk 630087
A. M. Perfil’ev
Federal Neurosurgical Center, Ministry of Health of Russia
Russian Federation
132/1 Nemirovicha-Danchenko St., Novosibirsk 630087
Russian Federation
132/1 Nemirovicha-Danchenko St., Novosibirsk 630087
References
1. Alshekhlee A., Mehta S., Edgell R.C. et al. Hospital mortality and complications of electively clipped or coiled unruptured intracranial aneurysm. Stroke 2010;41(7):1471–6. DOI: 10.1161/ STROKEAHA.110.580647.
2. Brinjikji W., Rabinstein A.A., Nasr D.M. et al. Better outcomes with treatment by coiling relative to clipping of unruptured intracranial aneurysms in the United States, 2001–2008. AJNR Am J Neuroradiol 2011;32(6):1071–5. DOI: 10.3174/ajnr. A2453.
3. Molyneux A., Kerr R., Stratton I. et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002; 360(9342):1267–74. PMID: 12414200.
4. White P.M., Lewis S.C., Gholkar A. et al. Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial. Lancet 2011;377(9778):1655–62. DOI: 10.1016/S0140-6736(11)60408-X.
5. Alghamdi F., Mine B., Morais R. et al. Stent-assisted coiling of intracranial aneurysms located on small vessels: midterm results with the LVIS Junior stent in 40 patients with 43 aneurysms. Neuroradiology 2016;58(7):665–71. DOI: 10.1007/s00234-016-1668-z.
6. Feng Z., Zhang L., Li Q. et al. Endovascular treatment of wide-neck anterior communicating artery aneurysms using the LVIS Junior stent. J Clin Neurosci 2015;22:1288–91.
7. Raymond J., Guilbert F., Weill A. et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003;34(6):1398–403. DOI: 10.1161/ 01.STR.0000073841.88563.E9.
8. Zhang X., Zhong J., Gao H. et al. Endovascular treatment of intracranial aneurysms with Lvis Jr device: a systematic review. J Neurointerv Surg 2017;9(6):553–7. DOI: 10.1136/neurintsurg-2016-012403.
9. Canton G., Levy D.I., Lasheras J.C. Hemodynamic changes due to stent placement in bifurcating intracranial aneurysms. J Neurosurg 2005;103(1):146–55. DOI: 10.3171/jns.2005.103.1.0146.
10. Kono K., Terada T. Hemodynamics of 8 different configurations of stenting for bifurcation aneurysms. AJNR Am J Neuroradiol 2013;34:1980–6.
11. Aydin K., Arat A., Sencer S. et al. Stentassisted coiling of wide-neck intracranial aneurysms using Low Profile LEO Baby stents: initial and midterm results. AJNR Am J Neuroradiol 2015;36(10):1934–41. DOI: 10.3174/ajnr.A4355.
12. Poncyljusz W., Biliński P., Safranow K. et al. The LVIS/LVIS Jr. stents in the treatment of wide-neck intracranial aneurysms: multicentre registry. J Neurointerv Surg 2014;7(7):524–9. DOI: 10.1136/neurintsurg-2014-011229.
13. King B., Vaziri S., Singla A. et al. Clinical and angiographic outcomes after stentassisted coiling of cerebral aneurysms with Enterprise and Neuroform stents: a comparative analysis of the literature. J Neurointerv Surg 2015;7(12):905–9. DOI: 10.1136/neurintsurg-2014-011457.
14. Nishido H., Piotin M., Bartolini B. et al. Analysis of complications and recurrences of aneurysm coiling with special emphasis on the stent-assisted technique. AJNR Am J Neuroradiol 2014;35(2):339–44.
15. Piotin M., Blanc R., Spelle L. et al. Stentassisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke 2010;41(1):110–5. DOI: 10.1161/STROKEAHA.109.558114.
Review
For citations:
Kiselev V.S., Gafurov R.R., Sosnov A.O., Perfil’ev A.M. USING OF LOW-PROFILE STENTS IN THE ENDOVASCULAR TREATMENT OF COMPLEX ANEURYSMS OF THE BRAIN. Russian journal of neurosurgery. 2018;20(1):49-55. (In Russ.) https://doi.org/10.17650/1683-3295-2018-20-1-49-55
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