Abstract
Aneurysm recurrence is an innate problem after coiling, and the recurrence rate is higher in complicated aneurysms. We evaluated the feasibility and efficacy of using the Willis covered stent in treating recurrent aneurysms after coil embolization. Eight aneurysms in 8 patients treated with detachable coils had confirmed recurrent aneurysms: 3 giant, 1 large, 1 dissecting, and 3 small wide-necked. The recurrent aneurysms involved C3 in 1 patient, C4 in 1, C7 in 5, and V4 in 1. A total of 11 covered stents were implanted into 8 target arteries. Follow-up angiography was performed 1-16 months after the procedure. Clinical follow-up data were collected and retrospectively analyzed, grading as fully recovered, improved, unchanged, or aggravated. Willis covered stent placement succeeded technically in all of the aneurysms. No technique-related adverse event occurred. Total occlusion was achieved immediately in 6 aneurysms, and a small endoleak was observed in 2 aneurysms. No mortality or morbidity occurred during or after the procedures, including during the follow-up period. Follow-up angiograms revealed that all 8 of the recurrent aneurysms were completely isolated, and 8 parent vessels kept patency, except 1 with mild stenosis. Clinical neurologic symptoms fully resolved in 5 patients, improved in 1, and were unchanged in 2 at the end of the follow-up period. In this small study with a middle-term follow-up, the Willis covered stent was used safely and effectively to occlude recurred aneurysms after coiling. Longer-term follow-up and additional clinical experience are needed to fully determine the safety and efficacy of the device.
Highlights
AND PURPOSE: Aneurysm recurrence is an innate problem after coiling, and the recurrence rate is higher in complicated aneurysms
All of the stented vessels kept patency, as demonstrated by immediate angiography; 5 aneurysms were completely occluded from the normal circulation immediately after the first stent graft deployment (Fig 2), 1 aneurysm achieved total occlusion when a second stent graft was used, and the remaining 2 aneurysms, covered by 1 stent and 3 stents, still showed slow and slight contrast filling of the cavity, but no additional stent was used, because spontaneous thrombosis may prompt occlusion (Fig 3)
No neurologic event related to the occlusion of side branches or perforating branches, including the ophthalmic artery (OA) and anterior choroidal artery (AchoA), occurred
Summary
Eight aneurysms in 8 patients treated with detachable coils had confirmed recurrent aneurysms: 3 giant, 1 large, 1 dissecting, and 3 small wide-necked. Patients and Recurrent Aneurysms From April 2005 to October 2007, 8 recurrent aneurysms after coiling in 8 patients were treated by using Willis covered stents in our department, the Sixth Affiliated People’s Hospital of Shanghai Jiao Tong University. Patient ages ranged from 33.0 to 51.0 years (mean, 43.6 years); there were 4 men and 4 women These 8 recurrent aneurysms consisted of 3 giant, 1 large, 1 dissecting, and 3 small wide-necked aneurysms; 5 aneurysms were located in C7 of the internal carotid artery (ICA), 1 was located in C3 of the ICA, 1 in C4 of the ICA, and 1 in V4 of the vertebral artery (VA). In 5 symptomatic patients, the primary cause of symptoms was due to the mass effect of the aneurysm after coiling (Table)
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