Leo stent for endovascular treatment of broad-necked and fusiform intracranial aneurysms

Abstract

The advent of intracranial stents has widened the indications for endovascular treatment of broad-necked and fusiform aneurysms. Leo stent is a self-expandable, nitinol, braided stent dedicated to intracranial vessels. The aim of this study is to present our experience in endovascular treatment of broad-necked and fusiform intracranial aneurysms using self-expanding, nitinol Leo stents. Between February 2004 and November 2006, 25 broad-necked and three fusiform aneurysms in 28 patients were treated using Leo stents in our centre. There were 18 patients who experienced acute subarachnoid haemorrhage due to aneurysm rupture, two patients who experienced SAH at least 12 months ago and in eight patients aneurysms were found incidentally. Aneurysms were located as follows: internal carotid artery (15), basilar artery (5), basilar tip (3), posterior inferior cerebral artery (2), M1/M2 segment (1), A2 segment (1) and vertebral artery (1). There were no difficulties with stent deployment and delivery. All patients after acute SAH (n=18) underwent stent implantation and coil embolization in one procedure. The remaining patients underwent coil embolization in a staged procedure. Immediate aneurysm occlusion of more than 95% was achieved in all patients who underwent stent placement and coil embolization in one procedure. There were three thromboembolic complications encountered in patients in an acute setting of SAH, preloaded only on acetylsalicylic acid. Use of abciximab led to patency within the stent and parent vessel. However, one of these patients presented rebleeding from the aneurysm during administration of abciximab and died. Application of Leo stents in cases of broadnecked and fusiform intracranial aneurysms is safe and effective with a low complication rate.

Figure 1

Scheme of Leo stent.

Figure 2

Method of determining the length of the needed stent with the aid of guidewire.

Figure 3

Angiograms of patient no. 1. A) Aneurysm located at the internal carotid artery. B) Partially coiled aneurysm with stent implanted. C) Total occlusion of the aneurysm with coils and stent, immediately after the procedure.

Figure 4

Angiograms of patient no. 2. A) Broad-necked aneurysm at the posterior inferior cerebellar artery. B) After stent implantation. C) Total occlusion of the aneurysm with coils and stent.

Figure 5

Angiograms of patient no. 13. A) Broad-necked aneurysm at the apex of the basilar artery. B) Radiopaque marker of microcatheter Vasco +21 placed in the posterior cerebral artery and the basilar artery. C) After stent implantation. Stent placed in the left posterior cerebral artery and the basilar artery. D) Total occlusion of the aneurysm with coils and stent.

Figure 6

Angiograms of patient no. 5. A) Broad-necked aneurysm at the apex of the basilar artery. B) After stent implantation. Stent placed in the right posterior cerebral artery and the basilar artery. C) Partial stent-supported coil embolization of the aneurysm. D) Complete occlusion of the aneurysm with coils and stent.

Figure 7

Angiograms of patient no. 11. A) Broad-necked aneurysm at the apex of the basilar artery. B) After stent placement into the left posterior cerebral artery and the basilar artery. Complete thrombosis of the basilar artery. C) After intraarterial administration of abciximab and coil embolization. Severe hemorrhage from the aneurysmal sack.

Figure 8

Angiograms of patient no. 8. A) Broad-necked aneurysm of the basilar artery. B) After stent placement. C) Complete occlusion of the aneurysm with coils and stent.

Figure 9

Angiograms of patient no. 19. A) 12 months after primary coils embolization. Recanalization of the aneurysm at the internal carotid artery. B) After stent placement. During coils packing. C) Complete occlusion of the aneurysm with coils and stent.

Figure 10

Angiograms of patient no. 7. A) After coil embolization of the aneurysm of the pericallosal artery. Microcatheter Vasco inside the aneurysm of the A2 segment of the anterior cerebral artery. B) Coils protrusion into the parent vessel. C) Complete occlusion of the aneurysm with stent and coils. D) Thrombosis in the distal segment of the anterior cerebral artery. Thrombus formation within the stent at the level of aneurysmal neck. E) After intraarterial administration of abciximab. Complete recanalization of the anterior cerebral artery.

Figure 11

Angiograms of patient no. 21. A) Fusiform aneurysm of the basilar artery. B) Directly after stent placement. No aneurysm occlusion. Free flow within the aneurysm and stent.

Figure 12

Angiograms of patient no. 17. A) Fusiform aneurysm of the vertebral artery prior to the procedure. B) Directly after stent placement. C) Follow-up scan 12 months after the procedure. Complete remodeling of the vertebral artery.