Stent-assisted endovascular treatment in intracranial aneursyms

Objective: The purpose of our research was to evaluate the efficiency and reliability of the stent-assisted treatment with or without coiling of intracranial aneurysms.Materials and Methods: Between October 2006 - June 2011, 32 female 30 male aged from 21 to 78 (mean: 53.4) years 62 patients in the aggregate were included in this study. 19 patients had subarachnoid hemorrhage and 3 of them were in acute phase. These patients had 97 intracranial aneurysms and 86 of aneurysms were treated with 25 Silk, 29 Enterprise, 26 Neuroform, 26 Leo, 6 Wingspan, 3 Pipeline, 2 Solitaire and 1 Jostent, 118 stents overall. 50 single stent, 14 telescopic, 13 Y configuration methods were used. Coil embolization was also used in 40 aneurysms.Results: In 86 aneurysms treatment, 7 of 118 stents couldn?t be replaced because of technical problems and 3 of them migrated (2.5%). Technical success ratio was 94.1% with replacement. In 7 patients, thrombus occured during the procedure (11.8%). Primary treatment was endovascular embolization with coil in 2 of them and endovascular embolization with stent in 5 of them. One of them died because of hemorrhage after thromboembolic treatment. One of them died 2 months after the procedure and one of them died because of rupture (mortality rate 4.8%). Transient neurologic deficit occured in 5 patients because of vasospasm and thromboembolic event (transient morbidity rate 8%). Left temporal enfarct occured because of total occlusion of one of the stents in one patient who was treated with Y configuration stent anddiscontinued antiaggregant therapy 3 months after procedure. 1.5 months after the procedure left frontotemporal abscess and cerebritis occured in one patient who had curettage one month after the procedure. In one of the patients, total occlusion occured because of thromboembolism on third day and the stent became patent with thromboembolic therapy (permanent morbidity rate 4.8%). The patient came to angiographic (mean 12.6 months) and clinical (mean 17.3 months) follow-ups after hospital discharge. Residual filling of the aneurysm neck was seen in 3 patients (3.5%) because the stents didn?t cover the aneurysms neck completely. 2 of them were treated with stent deployment to the neck of the aneurysms in different courses and total occlusion was achieved. Total occlusion was seen in 76 of 86 aneursyms (88.4%) on the twelfth month angiographic follow-up, occlusion over 90% was seen in 5 aneursyms (5.8%) and one of the aneursyms (1.1%) was recanalized. Stent stenosis above 50% was seen only in 3 (4.8%) patients.Conclusions: Endovascular treatment of intracranial aneursyms with stent-assisted coil embolization or only stent placement is oneffective and safe method aneursym treatment with a decreased recanalization rate.Key Words: Intracranial aneurysms, Intracranial stent, Endovascular embolization, Endovascular treatment