Broad-based intracranial aneurysms: thrombosis induced by stent placement

Abstract

For broad-based intracranial aneurysms, both surgical and endovascular treatments are demanding. Flexible metallic stents provide an alternative treatment option for these patients, because they enable coil placement through the stent mesh. Evidence from extracranial arteries indicates that aneurysms may also spontaneously thrombose after stent placement. This case report documents three patients with saccular intracranial aneurysms in whom aneurysm thrombosis occurred after stent placement only, without additional packing of the aneurysms with coils.

Fig 1.

Patient 1. A, Severe subarachnoid hemorrhage and mild hydrocephalus were detected by means of CT examination. The patient also had pulmonary edema at admittance. Four-vessel angiography revealed a saccular aneurysm in the lateral wall of the basilar artery trunk, located between the anterior inferior cerebellar arteries and superior cerebellar arteries. The left posterior cerebral artery filled from the carotid artery contrast medium injection (not shown). B, Self-expanding 5/24-mm coronary Wallstent (straight arrow) was deployed in the basilar artery over a Choice-PT extra-support guidewire (curved arrow). After deployment, the stent was fully patent and completely covered the base of the aneurysm. C, Aneurysm was totally thrombosed and stent remained patent on control angiogram obtained 6 months later.

Fig 2.

Patient 2. A, Angiogram shows a small broad-based blisterlike aneurysm on the lateral wall of the distal ICA on the right. A balloon-expanded stent has been advanced to the level of the aneurysm orifice but has not been dilated. The tip of the guidewire is in the middle cerebral artery. B, Angiogram obtained immediately after stent placement shows persistent but slower flow into the aneurysmal lumen. C, Control angiogram obtained 3 months after intervention shows that the ICA is fully patent and the aneurysm totally thrombosed.

Fig 3.

Patient 3. A, Angiogram shows two broad-based aneurysms in the anterior wall of the left ICA, located in the segment between the ophthalmic and posterior communicating arteries (arrows). B, Control angiogram obtained 3 months after the delivery of a metallic stent covering the orifice of both aneurysms. The more proximal aneurysm is totally occluded. The more distal aneurysm remains patent (arrow). C, Aneurysm remaining patent has been catheterized selectively and filled with GDCs (arrow).