Endovascular flow-diversion of visceral and renal artery aneurysms using dual-layer braided nitinol carotid stents

Penelope Van Veenendaal,Hamed Asadi,Tim Buckenham,Julian Maingard,Duncan Mark Brooks,Hong Kuan Kok,Ronil V Chandra,Michael J Lee,Dinesh Ranatunga

doi:10.1186/s42155-020-00125-2

Abstract

BackgroundVisceral and renal artery aneurysms (VRAAs) are uncommon but are associated with a high mortality rate in the event of rupture. Endovascular treatment is now first line in many centres, but preservation of arterial flow may be difficult in unfavourable anatomy including wide necked aneurysms, parent artery tortuosity and proximity to arterial bifurcations. Endovascular stenting, and in particular flow-diversion, is used in neurovascular intervention to treat intracranial aneurysms but is less often utilised in the treatment of VRAAs. The CASPER stent is a low profile dual-layer braided nitinol stent designed for carotid stenting with embolic protection and flow-diversion properties. We report the novel use of the CASPER stent for the treatment of VRAAs. We present a case series describing the treatment of six patients with VRAAs using the CASPER stent.ResultsSix patients with unruptured VRAAs were treated electively. There were three splenic artery aneurysms and three renalartery aneurysms. Aneurysms were treated with the CASPER stent, with or without loose aneurysm coil packing or liquid embolic depending on size and morphology. All stents were successfully deployed with no immediate or periprocedural complications. Four aneurysms completely occluded after serial imaging follow up with one case requiring repeat CASPER stenting for complete occlusion. In one patient a single aneurysm remained patent at last follow up, A single case was complicated by delated splenic infarction and surgical splenectomy.ConclusionPreliminary experience with the CASPER stent suggests it is technically feasible and effective for use in the treatment of VRAAs.

Highlights

Visceral and renal arterial aneurysms (VRAAs) are rare, with their incidence estimated at 0.1–2% (Berceli 2005; Pasha et al 2007; Belli et al 2012)
We present the initial experience, feasibility and shortterm results of using the CASPER stent to treat six cases of Visceral and renal artery aneurysms (VRAAs), including three splenic artery aneurysms and three renal artery aneurysms
Incidence of VRAAs is increasing due to widespread use of cross-sectional imaging, as well as a rise in invasive procedures resulting in iatrogenic aneurysms

Summary

Introduction

Visceral and renal arterial aneurysms (VRAAs) are rare, with their incidence estimated at 0.1–2% (Berceli 2005; Pasha et al 2007; Belli et al 2012). Elective treatment of patients at high risk of aneurysm rupture is preferred as presentation with rupture is associated with a high mortality rate (Shanley et al 1996; Carr et al 1996). Indications for treatment of true VRAAs are symptomatic aneurysms, size > 2.0 cm in diameter, increasing size on surveillance imaging, planned organ transplantation or donation and in women of childbearing age (Ha et al 2009). Visceral and renal artery aneurysms (VRAAs) are uncommon but are associated with a high mortality rate in the event of rupture. Endovascular stenting, and in particular flow-diversion, is used in neurovascular intervention to treat intracranial aneurysms but is less often utilised in the treatment of VRAAs. The CASPER stent is a low profile dual-layer braided nitinol stent designed for carotid stenting with embolic protection and flowdiversion properties. We present a case series describing the treatment of six patients with VRAAs using the CASPER stent

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Results

Conclusion