Revista argentina de neurocirugía
versión On-line ISSN 1850-1532
CASAGRANDE, Walter et al. Reconstrucción de arteria portadora en aneurismas cerebrales de cuello amplio con técnica de micro stent autoexpandible. Rev. argent. neurocir. [online]. 2007, vol.21, n.4, pp. 0-0. ISSN 1850-1532.
Introduction. Main limitation for complete occlusion of wide neck brain aneurysms is a major challenge for the Endovascular Technique. Stent assisted reconstruction of the parent vessel associated with coils embolization has been proposed as a solution. Retrospective analysis of effectiveness and complications in a series of thirty five wide neck aneurysms using the self expandable brain vessel dedicated stent Nueroform (Bostos Scientific) is described. Material and methods. In the tern of fifty months 530 brain aneurysms were treated by endovascular approach. Due to their anatomy in 35 of these, stent assisted reconstruction of the parent artery with or without coiling of the aneurysm sac was performed. Under antiplatelet therapy and anticoagulation Neuroform stents were deployed in the artery at the neck of the aneurysm followed by detachable coil occlusion of the sac itself. Results. Only in one case stent deployment could not be achieved. In thirty two cases stent assisted aneurysm coil embolization was performed while in two cases single stent deployment was done. In nine cases coil embolization had been performed previously and stent assisted coil embolization was performed in order to occlude the aneurysm neck. One patient died after a subarachnoid hemorrhage secondary to the treatment; another patient presented with a transient ischemic episode twelve days after the procedure and one patient had a retroperitoneal hematoma related to the artery puncture at the groin. Twenty five patients had three and twelve months follow up angiograms performed showing minimal compaction in four cases, and arterial stenosis at the site where stent has been deployed in three of them. In the twelve month angiogram one of these cases showed complete regression while the other two showed a mild reversion. Conclusions. Neuroform self expandable stent system allowed arterial wall reconstruction in 97% of cases of wide neck brain aneurysms increasing the rate of stabilization of coil occlusion. This technique still carries risks of ischemia and delayed intra stent stenotic phenomena reason for which it should be performed solely in those cases in which neck anatomy precludes sole coil embolization.
Palabras clave : Brain aneurysm; Embolization; Stent; Coils.