Retractable self-expandable stent for endovascular treatment of wide-necked intracranial aneurysms: preliminary experience

Abstract

Objective: Intracranial stenting combined with endosaccular coiling is a therapeutic alternative for the endovascular treatment (EVT) of wide-necked intracranial aneurysms. The current limitation of available stents is the impossibility to reposition them once they are partially deployed. Recently, the first retractable self-expandable stent has been developed and we sought to evaluate the use of this stent for EVT of wide-necked intracranial aneurysms.

Methods: Between March 2004 and March 2005, 11 patients with an unruptured aneurysm have been selected for this study. In all cases, previous attempts with EVT with the remodeling technique failed or was technically judged difficult. In all patients, EVT combined stent placement (Leo, Balt, Montmorency, France) across the aneurysm neck and subsequent coiling of the sac. Aneurysms were located on the carotid siphon (n = 9), the internal carotid artery bifurcation (n = 1), and the vertebral artery (n = 1). Aneurysms diameter size varied from 3 to 45 mm. Clinical outcome was assessed with the Modified Glasgow Outcome Scale.

Results: EVT was successfully performed and led to an excellent outcome in all patients. The stent could be navigated within cerebral arteries without any exchange procedure. Thanks to its retractability, the stent could precisely be positioned in all cases. Angiographic results consisted of 9 complete occlusions and 2 incomplete occlusions in 2 giant aneurysms. No procedure-related complication occurred.

Conclusion: The Leo stent appears very useful for EVT of wide-necked intracranial aneurysms. The advantage of this stent is the possibility to reposition it which allows a very precise positioning across the aneurysm neck.