Abstract
Subarachnoid hemorrhage due to a ruptured cerebral aneurysm is a disastrous event accounting for approximately 5%-15% of all stroke cases and has a high mortality rate. One of the major goals in the management of these patients is to prevent rebleeding by securing the aneurysm either surgically or by endovascular means. Endovascular treatment is considered the first line of treatment for intracranial aneurysms; however, wide-neck aneurysms (WNAs) are specifically difficult to treat by endovascular means due to the difficulty in achieving a stable coil mass inside the aneurysm sac. To overcome this problem, assisted endovascular treatment techniques and devices have evolved over the years. Amongst these, stent-assisted coiling (SAC) techniques provide a scaffold for coil embolization. The concept of the stent-assisted technique inspired creative pioneers to invent new tools like the PulseRider (Pulsar Vascular, Inc. CA, USA) and the pCONUS (Phenox GmbH, Germany), which are a great help in managing wide-neck and bifurcation aneurysms. The concept of stent within stents and its related hemodynamic effect has led to the novel development of flow diverters for reconstructing the arterial wall and correcting the hemodynamic disturbances. In this article, we review the stents and stent-like devices currently in practice for the endovascular management of wide-neck and branch intracranial aneurysms.
Highlights
BackgroundFollowing the publication of the ISAT (International Subarachnoid Aneurysm Trial) in 2002 and the ISUIA (International Study of Unruptured Intracranial Aneurysms) in 2003, endovascular means have become the management of first-choice for intracranial aneurysms [1,2].The endovascular treatment of intracranial aneurysms has evolved over the years both in regard to neurointerventional skills as well as the advent of advanced techniques and innovative devices to render the treatment more effective and durable
The advent of Guglielmi detachable coils (GDC) coils paved the way for the development of improvement in coil technology and the addition of 3D coils, bioactive, How to cite this article Khattak Y J, Sibaie A A, Anwar M, et al (October 05, 2018) Stents and Stent Mimickers in Endovascular Management of Wide-neck Intracranial Aneurysms
The subarachnoid hemorrhage (SAH) rate was 0.03% while the procedure-related permanent morbidity was 2.41% [34]. These results depict that the use of flow diverters for wide-neck aneurysms is still associated with uncertainties; the use of flow diverters in small-sized or blister-like aneurysms, aneurysms at vessel bifurcations, or cases of dysplastic vessel segments with multiple aneurysms requires further studies to evaluate their efficacy and safety [27]
Summary
Following the publication of the ISAT (International Subarachnoid Aneurysm Trial) in 2002 and the ISUIA (International Study of Unruptured Intracranial Aneurysms) in 2003, endovascular means have become the management of first-choice for intracranial aneurysms [1 ,2]. Various studies comprising retrospective series have reported heterogeneous complication rates, stent-assisted coiling remains a well-established and useful technique for endovascular management of wide-neck aneurysms [16,17,18]. The subarachnoid hemorrhage (SAH) rate was 0.03% while the procedure-related permanent morbidity was 2.41% [34] These results depict that the use of flow diverters for wide-neck aneurysms is still associated with uncertainties; the use of flow diverters in small-sized or blister-like aneurysms, aneurysms at vessel bifurcations, or cases of dysplastic vessel segments with multiple aneurysms requires further studies to evaluate their efficacy and safety [27]
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