Purpose: To evaluate the safety and efficacy of Enterprise stent in the treatment of symptomatic complex intracranial atherosclerotic stenosis. Methods and materials: 20 complex cases among 53 patients with symptomati...Purpose: To evaluate the safety and efficacy of Enterprise stent in the treatment of symptomatic complex intracranial atherosclerotic stenosis. Methods and materials: 20 complex cases among 53 patients with symptomatic ischemic stroke who were treated with balloon angioplasty and enterprise stents in Department of Neuro-interventional Radiology, The First Affiliated Hospital of Zhengzhou University from Jan. 2014 to Dec. 2017 were retrospectively enrolled in this study. Diagnostic criteria for complex intracranial atherosclerotic stenosis were as follows: 1) intracranial atherosclerotic stenosis was ≥70% confirmed by digital subtraction angiography(DSA) using the formulas described by the Warfarin Aspirin Symptomatic Intracranial Disease(WASID) method; 2) length of lesion was >10 mm. Basic characteristics of target lesions, technical success rate, perioperative safety, follow-up outcomes were investigated. Results: 20 patients were enrolled in this study, including 15 males and 5 females from 44 to 70 years old with an average age of 57.20 ± 9.25. 20 lesions were treated with 20 enterprise stents. The average preoperative and postoperative residual stenosis was reduced from(77.45 ± 8.44)% to(24.89 ± 16.61)%. The successful rate of operation was 100%. Among the perioperative complications, only 1 case(5%) experienced perforating branch event. The average clinical follow-up period was 13.15 ± 11.33 months(time range: 5–38). There were no ischemic events, no bleeding events and no various causes of death during the follow-up period. 8 lesions(40.0%) underwent DSA follow-up examinations and 12 lesions(60.0%) were checked by CT angiography during the follow-up period. 3 lesions(15.0%) developed ISR without any cerebral ischemia symptoms. Conclusion: This retrospective, single-center study suggests that enterprise stent is effective in the treatment of symptomatic complex intracranial atherosclerotic stenosis with less perioperative complications. Prospective, multicenter, randomized controlled trials are expected.展开更多
Objective and Importance—Vertebrobasilar artery aneurysms can be very challenging to treat and are preferentially dealt with using endovascular tech-niques, since they are associated with lower risk than surgical cli...Objective and Importance—Vertebrobasilar artery aneurysms can be very challenging to treat and are preferentially dealt with using endovascular tech-niques, since they are associated with lower risk than surgical clipping. Small aneurysms located on perfo-rating arteries can pose problems though, as their dimensions may not be favorable for coiling and leave the endovascular surgeon without many options. We present a basilar perforating artery aneurysm that was successfully embolized using a stent-within-stent technique. Clinical Presentation—A 47 year old fe-male presented with a Hunt-Hess 3, Fisher Grade-3 subarachnoid hemorrhage with blood in the pre-pontine cistern. Initial imaging (CT angiogram and digital subtraction angiography) did not reveal an aneurysm. Follow-up angiography on post-bleed day eight demonstrated a three-millimeter basilar perforating artery aneurysm. After an unsuccessful coiling attempt a closed-cell stent-within-stent tech-nique was used to divert flow away from the aneu-rysm neck to induce aneurysm thrombosis. Interven-tion (or Technique)—Multiple attempts were made to access and stabilize a microcatheter in the small basilar perforator artery aneurysm in order to de-liver coils for endovascular embolization;this could not be done safely. Therefore a closed-cell 4.5 × 22 mm Enterprise stent (Cordis Neurovascular, Inc., Miami Lakes, Florida) was deployed in the basilar artery across the origin of the perforator aneurysm in order for the stent tines to divert flow away from the aneurysm neck and induce thrombosis. Persistant brisk flow within the aneurysm continued however, and a second closedcell 4.5 × 22 mm Enterprise stent was placed within the first one to increase the stent metal surface area across the aneurysm neck to further reduce flow into the aneurysm. Subsequently, angiography demonstrated stagnant blood flow in the aneurysm dome and the aneurysm spontaneously thrombosed, sparing all associated vessels. Conclu-sion—Stent-within-stent technique should be consid-ered as a possible endovascular treatment option for small side-wall and perforator artery aneurysms that can’t be safely treated with coils or embolic agents.展开更多
文摘Purpose: To evaluate the safety and efficacy of Enterprise stent in the treatment of symptomatic complex intracranial atherosclerotic stenosis. Methods and materials: 20 complex cases among 53 patients with symptomatic ischemic stroke who were treated with balloon angioplasty and enterprise stents in Department of Neuro-interventional Radiology, The First Affiliated Hospital of Zhengzhou University from Jan. 2014 to Dec. 2017 were retrospectively enrolled in this study. Diagnostic criteria for complex intracranial atherosclerotic stenosis were as follows: 1) intracranial atherosclerotic stenosis was ≥70% confirmed by digital subtraction angiography(DSA) using the formulas described by the Warfarin Aspirin Symptomatic Intracranial Disease(WASID) method; 2) length of lesion was >10 mm. Basic characteristics of target lesions, technical success rate, perioperative safety, follow-up outcomes were investigated. Results: 20 patients were enrolled in this study, including 15 males and 5 females from 44 to 70 years old with an average age of 57.20 ± 9.25. 20 lesions were treated with 20 enterprise stents. The average preoperative and postoperative residual stenosis was reduced from(77.45 ± 8.44)% to(24.89 ± 16.61)%. The successful rate of operation was 100%. Among the perioperative complications, only 1 case(5%) experienced perforating branch event. The average clinical follow-up period was 13.15 ± 11.33 months(time range: 5–38). There were no ischemic events, no bleeding events and no various causes of death during the follow-up period. 8 lesions(40.0%) underwent DSA follow-up examinations and 12 lesions(60.0%) were checked by CT angiography during the follow-up period. 3 lesions(15.0%) developed ISR without any cerebral ischemia symptoms. Conclusion: This retrospective, single-center study suggests that enterprise stent is effective in the treatment of symptomatic complex intracranial atherosclerotic stenosis with less perioperative complications. Prospective, multicenter, randomized controlled trials are expected.
文摘Objective and Importance—Vertebrobasilar artery aneurysms can be very challenging to treat and are preferentially dealt with using endovascular tech-niques, since they are associated with lower risk than surgical clipping. Small aneurysms located on perfo-rating arteries can pose problems though, as their dimensions may not be favorable for coiling and leave the endovascular surgeon without many options. We present a basilar perforating artery aneurysm that was successfully embolized using a stent-within-stent technique. Clinical Presentation—A 47 year old fe-male presented with a Hunt-Hess 3, Fisher Grade-3 subarachnoid hemorrhage with blood in the pre-pontine cistern. Initial imaging (CT angiogram and digital subtraction angiography) did not reveal an aneurysm. Follow-up angiography on post-bleed day eight demonstrated a three-millimeter basilar perforating artery aneurysm. After an unsuccessful coiling attempt a closed-cell stent-within-stent tech-nique was used to divert flow away from the aneu-rysm neck to induce aneurysm thrombosis. Interven-tion (or Technique)—Multiple attempts were made to access and stabilize a microcatheter in the small basilar perforator artery aneurysm in order to de-liver coils for endovascular embolization;this could not be done safely. Therefore a closed-cell 4.5 × 22 mm Enterprise stent (Cordis Neurovascular, Inc., Miami Lakes, Florida) was deployed in the basilar artery across the origin of the perforator aneurysm in order for the stent tines to divert flow away from the aneurysm neck and induce thrombosis. Persistant brisk flow within the aneurysm continued however, and a second closedcell 4.5 × 22 mm Enterprise stent was placed within the first one to increase the stent metal surface area across the aneurysm neck to further reduce flow into the aneurysm. Subsequently, angiography demonstrated stagnant blood flow in the aneurysm dome and the aneurysm spontaneously thrombosed, sparing all associated vessels. Conclu-sion—Stent-within-stent technique should be consid-ered as a possible endovascular treatment option for small side-wall and perforator artery aneurysms that can’t be safely treated with coils or embolic agents.
