P-019 Mid-term results of single or multiple overlapping neuroform stents as monotherapy for treating supraclinoid carotid "blister-like" pseudoaneurysms. (4th July 2012) - Spiotta, A
Abstract : Introduction: "Blister-like" pseudoaneurysms of the supraclinoid internal carotid artery have a malignant natural history and can be difficult to treat, both surgically and via endovascular techniques. These lesions often involve a long arterial segment and lack a defined saccular component that would safely accommodate the introduction of embolization coils. This report describes follow-up data from patients who underwent Neuroform stent reconstruction as monotherapy. Methods: A retrospective review was performed on a prospectively maintained Neuroform stent database at our institution. Patients who had undergone stent reconstruction of supraclinoid ICA "blister-like" aneurysms were included. Long-term clinical and angiographic data was obtained and analyzed. Results: Eight patients were identified (mean age 61.1 years; five female, three male) who underwent stent reconstruction using Neuroform stents; seven (87.5%) were treated in the ruptured setting. Three patients presented in Hunt and Hess (HH) grade 2, two in HH3, and one presented months after rupture, with no documented HH score. All patients underwent endovascular Neuroform stenting of their aneurysms. Initial angiographic results were as follows: complete occlusion (Raymond 1; n=3; 37.5%) and residual aneurysm (Raymond 3; n=5; 62.5%). There were no intraprocedural complications. There were no cases of re-bleeding. Clinical follow-up data (range 1–34 months; average 12.4 m) was obtained from all patients and angiographic follow-up data (range 1–28 months; average 10.9 m) was obtained from seven patients (87.5%). Follow-up angiographic results are as follows: complete occlusion (Raymond 1; n=6; 75%) and residual aneurysm (Raymond 3; n=2; 25%). Clinical outcomes are as follows: mRS of 0 (n=2; 25%), mRS of 1 (n=5; 62.5%) and mRS of 2 (n=1, 12.5%). No patients had mRS of 3 or greater. Two patients (25%) required retreatment, one required ICA sacrifice with STA-MCA bypass, and the other required emergent endovascular intervention with abciximab for stent thrombosis. Neither of these patients suffered permanent neurological deficits. Conclusion: Endovascular stent reconstruction of supraclinoid ICA "blister-type" aneurysms using the Neuroform stent is an effective treatment option even in the setting of subarachnoid hemorrhage. Stent reconstruction prevents aneurysmal reruptures and is associated with favorable long-term clinical and angiographic outcomes. Competing interests: A Spiotta: Integra, Hemedex. K Walsh: None. T Bhalla: None. F Hui: None.