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Published in: European Radiology 1/2013

01-01-2013 | Vascular-Interventional

Frequency and predictors of endoleaks and long-term patency after covered stent placement for the treatment of intracranial aneurysms: a prospective, non-randomised multicentre experience

Authors: Yue-Qi Zhu, Ming-Hua Li, Feng Lin, Dong-Lei Song, Hua-Qiao Tan, Bin-Xian Gu, Hong-Qi Zhang, Bin Leng, Pei-Lei Zhang

Published in: European Radiology | Issue 1/2013

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Abstract

Objective

We investigated immediate/late endoleaks and long-term patency following stent-graft placement for treatment of intracranial aneurysms located within the distal internal carotid artery (ICA) or vertebral artery (VA).

Methods

Forty-five aneurysms in 41 patients receiving covered stents in three centres were followed. Outcome measures included aneurysm occlusion rate, endoleaks, late in-stent stenosis rate, clinical improvement, neurological deficiencies and death.

Results

Total aneurysm exclusion was achieved in 69.2% (n = 27), with 30.8% (n = 12) experiencing immediate residual endoleaks. Angiographic follow-up (mean 43.5 ± 14.3 months) revealed that 87.2% (n = 34) were completely occluded with only 12.8% (n = 5) showing residual endoleaks. Predictors of immediate endoleaks in our patient group were stent number (P = 0.023) and stent diameter (P = 0.022), while predictors of late endoleaks in our patient group were stent diameter (P = 0.035) and stent angulation (P = 0.021). Late in-stent stenosis rates were 18.0 ± 13.3 and 29.0 ± 18.5% compared with the period immediately following implantation at 2- and 6-year follow-ups respectively. Smoking (P = 0.017) and stent angulation (P = 0.020) were predictors of late in-stent stenosis.

Conclusion

Treating intracranial aneurysms with Willis stent-grafts has an acceptable immediate and late occlusion rate and long-term stented artery patency rate.

Key Points

Covered stents can be a treatment option for intracranial aneurysms.
Technical success for treating distal ICA and VA aneurysms can reach 97.6%.
However immediate and late endoleaks occur in 30.8 and 12.8% respectively.
The number, diameter and angulation of stents are possible predictors of endoleaks.
Smoking and stent angulation seem to predict late in-stent stenosis.
Literature
1.
2.
go back to reference Wakhloo AK, Lanzino G, Lieber BB et al (1998) Stents for intracranial aneurysms: the beginning of a new endovascular era? Neurosurgery 43:377–383PubMedCrossRef Wakhloo AK, Lanzino G, Lieber BB et al (1998) Stents for intracranial aneurysms: the beginning of a new endovascular era? Neurosurgery 43:377–383PubMedCrossRef
3.
go back to reference Islak C, Kocer N (2002) Bare stent-graft technique: a new method of endoluminal vascular reconstruction for the treatment of giant and fusiform aneurysms. AJNR Am J Neuroradiol 23:1589–1595PubMed Islak C, Kocer N (2002) Bare stent-graft technique: a new method of endoluminal vascular reconstruction for the treatment of giant and fusiform aneurysms. AJNR Am J Neuroradiol 23:1589–1595PubMed
4.
go back to reference Auyeung KM, Lui WM, Chow LC et al (2003) Massive epistaxis related to petrous carotid artery pseudoaneurysm after radiation therapy: emergency treatment with covered stent in two cases. AJNR Am J Neuroradiol 24:1449–1452PubMed Auyeung KM, Lui WM, Chow LC et al (2003) Massive epistaxis related to petrous carotid artery pseudoaneurysm after radiation therapy: emergency treatment with covered stent in two cases. AJNR Am J Neuroradiol 24:1449–1452PubMed
5.
go back to reference Saatci I, Cekirge HS, Ozturk MH et al (2004) Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with mid-term follow-up results. AJNR Am J Neuroradiol 25:1742–1749PubMed Saatci I, Cekirge HS, Ozturk MH et al (2004) Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with mid-term follow-up results. AJNR Am J Neuroradiol 25:1742–1749PubMed
6.
go back to reference Li MH, Zhu YQ, Fang C et al (2008) The feasibility and efficacy of treatment with a Willis covered stent in recurrent intracranial aneurysms after coiling. AJNR Am J Neuroradiol 29:1395–1400PubMedCrossRef Li MH, Zhu YQ, Fang C et al (2008) The feasibility and efficacy of treatment with a Willis covered stent in recurrent intracranial aneurysms after coiling. AJNR Am J Neuroradiol 29:1395–1400PubMedCrossRef
7.
go back to reference Zhu YQ, Li MH, Fang C et al (2010) Application of the Willis covered stent in the treatment of aneurysm in the cisternal segment of the internal carotid artery: a pilot comparative study with midterm follow-up. J Endovasc Ther 17:55–65PubMedCrossRef Zhu YQ, Li MH, Fang C et al (2010) Application of the Willis covered stent in the treatment of aneurysm in the cisternal segment of the internal carotid artery: a pilot comparative study with midterm follow-up. J Endovasc Ther 17:55–65PubMedCrossRef
8.
go back to reference Li MH, Li YD, Tan HQ et al (2009) Treatment of distal internal carotid artery aneurysm with the Willis covered stent: a prospective pilot study. Radiology 253:470–477PubMedCrossRef Li MH, Li YD, Tan HQ et al (2009) Treatment of distal internal carotid artery aneurysm with the Willis covered stent: a prospective pilot study. Radiology 253:470–477PubMedCrossRef
9.
go back to reference Grunwald IQ, Kamran M, Corkill RA et al (2012) Simple measurement of aneurysm residual after treatment: the SMART scale for evaluation of intracranial aneurysms treated with flow diverters. Acta Neurochir (Wien) 154:21–26CrossRef Grunwald IQ, Kamran M, Corkill RA et al (2012) Simple measurement of aneurysm residual after treatment: the SMART scale for evaluation of intracranial aneurysms treated with flow diverters. Acta Neurochir (Wien) 154:21–26CrossRef
10.
go back to reference Kawaguchi S, Sakaki T, Iwahashi H et al (2006) Effect of carotid artery stenting on ocular circulation and chronic ocular ischemic syndrome. Cerebrovasc Dis 22:402–408PubMedCrossRef Kawaguchi S, Sakaki T, Iwahashi H et al (2006) Effect of carotid artery stenting on ocular circulation and chronic ocular ischemic syndrome. Cerebrovasc Dis 22:402–408PubMedCrossRef
11.
go back to reference Hupperts RM, Lodder J, Heuts-van Raak EP et al (1994) Infarcts in the anterior choroidal artery territory. Anatomical distribution, clinical syndromes, presumed pathogenesis and early outcome. Brain 117:825–834PubMedCrossRef Hupperts RM, Lodder J, Heuts-van Raak EP et al (1994) Infarcts in the anterior choroidal artery territory. Anatomical distribution, clinical syndromes, presumed pathogenesis and early outcome. Brain 117:825–834PubMedCrossRef
12.
go back to reference Yang JH, Choi HY, Nam HS et al (2007) Mechanism of infarction involving ipsilateral carotid and posterior cerebral artery territories. Cerebrovasc Dis 24:445–451PubMedCrossRef Yang JH, Choi HY, Nam HS et al (2007) Mechanism of infarction involving ipsilateral carotid and posterior cerebral artery territories. Cerebrovasc Dis 24:445–451PubMedCrossRef
13.
go back to reference Chuter TA, Faruqi RM, Sawhney R et al (2001) Endoleak after endovascular repair of abdominal aortic aneurysm. J Vasc Surg 34:98–105PubMedCrossRef Chuter TA, Faruqi RM, Sawhney R et al (2001) Endoleak after endovascular repair of abdominal aortic aneurysm. J Vasc Surg 34:98–105PubMedCrossRef
14.
go back to reference Stavropoulos SW, Charagundla SR (2007) Imaging techniques for detection and management of endoleaks after endovascular aortic aneurysm repair. Radiology 243:641–655PubMedCrossRef Stavropoulos SW, Charagundla SR (2007) Imaging techniques for detection and management of endoleaks after endovascular aortic aneurysm repair. Radiology 243:641–655PubMedCrossRef
15.
go back to reference Hoit DA, Schirmer CM, Malek AM (2008) Stent graft treatment of cerebrovascular wall defects: intermediate-term clinical and angiographic results. Neurosurgery 62:ONS380–ONS388PubMedCrossRef Hoit DA, Schirmer CM, Malek AM (2008) Stent graft treatment of cerebrovascular wall defects: intermediate-term clinical and angiographic results. Neurosurgery 62:ONS380–ONS388PubMedCrossRef
16.
go back to reference Lang J (1983) Clinical anatomy of brainstem vessels. Miles Pharmaceutical, New Haven Lang J (1983) Clinical anatomy of brainstem vessels. Miles Pharmaceutical, New Haven
17.
go back to reference Zhu YQ, Li MH, Xie J et al (2010) Treatment of carotid siphon aneurysms by use of the Willis stent graft: an angiographic and histopathological study. Eur Radiol 20:1974–1984PubMedCrossRef Zhu YQ, Li MH, Xie J et al (2010) Treatment of carotid siphon aneurysms by use of the Willis stent graft: an angiographic and histopathological study. Eur Radiol 20:1974–1984PubMedCrossRef
18.
go back to reference Fisher AB, Chien S, Barakat AI et al (2001) Endothelial cellular response to altered shear stress. Am J Physiol Lung Cell Mol Physiol 281:L529–L533PubMed Fisher AB, Chien S, Barakat AI et al (2001) Endothelial cellular response to altered shear stress. Am J Physiol Lung Cell Mol Physiol 281:L529–L533PubMed
19.
go back to reference Wei Z, Costa K, Al-Mehdi AB et al (1999) Simulated ischemia in flow-adapted endothelial cells leads to generation of reactive oxygen species and cell signaling. Circ Res 85:682–699PubMedCrossRef Wei Z, Costa K, Al-Mehdi AB et al (1999) Simulated ischemia in flow-adapted endothelial cells leads to generation of reactive oxygen species and cell signaling. Circ Res 85:682–699PubMedCrossRef
20.
go back to reference Fowkes FG, Housley E, Riemersma RA et al (1992) Smoking, lipids, glucose tolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study. Am J Epidemiol 135:331–340PubMed Fowkes FG, Housley E, Riemersma RA et al (1992) Smoking, lipids, glucose tolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study. Am J Epidemiol 135:331–340PubMed
21.
go back to reference Drexel H, Steurer J, Muntwyler J et al (1996) Predictors of the presence and extent of peripheral arterial occlusive disease. Circulation 94:II199–II205PubMed Drexel H, Steurer J, Muntwyler J et al (1996) Predictors of the presence and extent of peripheral arterial occlusive disease. Circulation 94:II199–II205PubMed
22.
go back to reference Schillinger M, Exner M, Mlekusch W et al (2004) Effect of smoking on restenosis during the first year after lower-limb endovascular interventions. Radiology 231:831–838PubMedCrossRef Schillinger M, Exner M, Mlekusch W et al (2004) Effect of smoking on restenosis during the first year after lower-limb endovascular interventions. Radiology 231:831–838PubMedCrossRef
23.
go back to reference Stayman AN, Nogueira RG, Gupta R (2011) A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis. Stroke 42:2212–2216PubMedCrossRef Stayman AN, Nogueira RG, Gupta R (2011) A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis. Stroke 42:2212–2216PubMedCrossRef
24.
go back to reference Lylyk P, Miranda C, Ceratto R et al (2009) Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery 64:632–642PubMedCrossRef Lylyk P, Miranda C, Ceratto R et al (2009) Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery 64:632–642PubMedCrossRef
25.
go back to reference Nelson PK, Lylyk P, Szikora I et al (2011) The pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR Am J Neuroradiol 32:34–40PubMedCrossRef Nelson PK, Lylyk P, Szikora I et al (2011) The pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR Am J Neuroradiol 32:34–40PubMedCrossRef
26.
go back to reference Deutschmann HA, Wehrschuetz M, Augustin M et al (2012) Long-term follow-up after treatment of intracranial aneurysms with the pipeline embolization device: results from a single center. AJNR Am J Neuroradiol 33:481–486PubMedCrossRef Deutschmann HA, Wehrschuetz M, Augustin M et al (2012) Long-term follow-up after treatment of intracranial aneurysms with the pipeline embolization device: results from a single center. AJNR Am J Neuroradiol 33:481–486PubMedCrossRef
27.
go back to reference Fiorella D, Woo HH, Albuquerque FC et al (2008) Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the pipeline embolization device. Neurosurgery 62:1115–1120PubMedCrossRef Fiorella D, Woo HH, Albuquerque FC et al (2008) Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the pipeline embolization device. Neurosurgery 62:1115–1120PubMedCrossRef
28.
go back to reference McAuliffe W, Wenderoth JD (2012) Immediate and midterm results following treatment of recently ruptured intracranial aneurysms with the pipeline embolization device. AJNR Am J Neuroradiol 33:487–493PubMedCrossRef McAuliffe W, Wenderoth JD (2012) Immediate and midterm results following treatment of recently ruptured intracranial aneurysms with the pipeline embolization device. AJNR Am J Neuroradiol 33:487–493PubMedCrossRef
29.
go back to reference van Rooij WJ, Sluzewski M (2010) Perforator infarction after placement of a pipeline flow-diverting stent for an unruptured A1 aneurysm. AJNR Am J Neuroradiol 31:E43–E44PubMedCrossRef van Rooij WJ, Sluzewski M (2010) Perforator infarction after placement of a pipeline flow-diverting stent for an unruptured A1 aneurysm. AJNR Am J Neuroradiol 31:E43–E44PubMedCrossRef
30.
go back to reference Fiorella D, Hsu D, Woo HH et al (2010) Very late thrombosis of a pipeline embolization device construct: case report. Neurosurgery 67:onsE313–onsE314PubMedCrossRef Fiorella D, Hsu D, Woo HH et al (2010) Very late thrombosis of a pipeline embolization device construct: case report. Neurosurgery 67:onsE313–onsE314PubMedCrossRef
31.
go back to reference Hampton T, Walsh D, Tolias C et al (2011) Mural destabilization after aneurysm treatment with a flow-diverting device: a report of two cases. J Neurointerv Surg 3:167–171PubMedCrossRef Hampton T, Walsh D, Tolias C et al (2011) Mural destabilization after aneurysm treatment with a flow-diverting device: a report of two cases. J Neurointerv Surg 3:167–171PubMedCrossRef
32.
go back to reference Kulcsar Z, Houdart E, Bonafe A et al (2011) Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 32:20–25PubMedCrossRef Kulcsar Z, Houdart E, Bonafe A et al (2011) Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 32:20–25PubMedCrossRef
Metadata
Title
Frequency and predictors of endoleaks and long-term patency after covered stent placement for the treatment of intracranial aneurysms: a prospective, non-randomised multicentre experience
Authors
Yue-Qi Zhu
Ming-Hua Li
Feng Lin
Dong-Lei Song
Hua-Qiao Tan
Bin-Xian Gu
Hong-Qi Zhang
Bin Leng
Pei-Lei Zhang
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
European Radiology / Issue 1/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2581-4

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