Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

In-Stent Stenosis of Stent Assisted Endovascular Treatment on Intracranial Complex Aneurysms

  • Yoon, Kyeong-Wook (Department of Neurosurgery, Dankook University College of Medicine) ;
  • Kim, Young-Joon (Department of Neurosurgery, Dankook University College of Medicine)
  • Received : 2010.08.19
  • Accepted : 2010.12.29
  • Published : 2010.12.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : To introduce the frequency and segment analysis of in-stent stenosis for intracranial stent assisted endovascular treatment on complex aneurysms. Methods : A retrospective study was performed in 158 patients who had intracranial complex aneurysms and were treated by endovascular stent application with or without coil embolization. Of these, 102 patients were evaluated with catheter based angiography after 6, 12, and 18 months. Aneurysm location, using stent, time to stenosis, stenosis rate and narrowing segment were analyzed. Results : Among follow-up cerebral angiography done in 102 patients, 8 patients (7.8%) were shown an in-stent stenosis. Two patients have unruptured aneurysm and six patients have ruptured one. Number of Neuroform stents were 7 cases (7.5%) and Enterprise stent in 1 case (11.1%). Six patients demonstrated in-stent stenosis at 6 months after stent application and remaining two patients were shown at 12 months, 18 months, respectively. Conclusion : In-stent stenosis can be confronted after intracranial stent deployment. In our study, no patient showed symptomatic stenosis and there were no patients who required to further treatment except continuing antiplatets medication. In-stent stenosis has been known to be very few when they are placed into the non-pathologic parent artery during the complex aneurysm treatment, but the authors found that it was apt to happen on follow up angiography. Although the related symptom was not seen in our cases, the luminal narrowing at the stented area may result the untoward hemodynamic event in the specific condition.

Keywords

References

  1. Bose A, Hartmann M, Henkes H, Liu HM, Teng MM, Szikora I, et al. : A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses : the Wingspan study. Stroke 38 : 1531-1537, 2007 https://doi.org/10.1161/STROKEAHA.106.477711
  2. Chimowitz M, Lynn M, Howlett-Smith H, Stern B, Hertzberg V, Frankel M, et al. : Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 352 : 1305-1316, 2005 https://doi.org/10.1056/NEJMoa043033
  3. Fiorella D, Albuquerque F, Deshmukh V, McDougall C. : In-stent stenosis as a delayed complication of Neuroform stent-supported coil embolization of an incidental carotid terminus aneurysm. AJNR Am J Neuroradiol 25 : 1764-1767, 2004
  4. Fiorella D, Albuquerque F, Woo H, Rasmussen P, Masaryk T, McDougall C : Neuroform in-stent stenosis : incidenace, natural history, and treatment strategies. Neurosurgery 59 : 34-42, 2006 https://doi.org/10.1227/01.NEU.0000219853.56553.71
  5. Higashida R, Smith W, Gress D, Urwin R, Dowd C, Balousek P, et al. : Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. J Neurosurg 87 : 944-949, 1997 https://doi.org/10.3171/jns.1997.87.6.0944
  6. Hoffmann R, Mintz G, Dussaillant G, Popma J, Pichard A, Satler L, et al. : Patterns and mechanisms of in-stent restenosis: a serial intravascular ultrasound study. Circulation 94 : 1247-1254, 1996 https://doi.org/10.1161/01.CIR.94.6.1247
  7. Hoit D, Malek A : Three-dimensional rotational angiographic detection of in-stent stenosis in wide-necked aneurysm treated with a selfexpanding intracranial stent. Neurosurgery 57 : 1228-1236, 2005 https://doi.org/10.1227/01.NEU.0000186026.12709.BC
  8. Kearney M, Pieczek A, Haley L, Losordo D, Andres V, Schainfeld R, et al. : Histopathology of in-stent restenosis in patients with peripheral artery disease. Circulation 95 : 1998-2002, 1997 https://doi.org/10.1161/01.CIR.95.8.1998
  9. Kipshidze N, Dangas G, Tsapenko M, Moses J, Leon M, Kutryk M, et al. : Role of the endothelium in modulating neointimal formation : Vasculoprotective approaches to attenuate restenosis after percutaneous coronary interventions. J Am Coll Cardiol 44 : 733-739, 2004
  10. Layton K, Hise J, Thacker I : Recurrent intracranial stenosis induced by the Wingspan stent: comparison with balloon angioplasty alone in a single patient. AJNR Am J Neuroradiol 29 : 1050-1052, 2008 https://doi.org/10.3174/ajnr.A1006
  11. Lowe H, Oesterle S, Khachigian L : Coronary in-stent restenosis : current status and future strategies. J Am Coll Cardiol 39 : 183-193, 2002
  12. Marks M, Wojak J, Al-Ali F, Jayaraman M, Marcellus M, Connors J, et al. : Angioplasty for symptomatic intracranial stenosis : clinical outcome. Stroke 37 : 1016-1020, 2006 https://doi.org/10.1161/01.STR.0000206142.03677.c2
  13. Schatz R, Palmaz J, Tio F, Garcia F, Garcia O, Reuter S : Balloonexpandable intracoronary stents in the adult dog. Circulation 76 : 450-457, 1987 https://doi.org/10.1161/01.CIR.76.2.450
  14. Sillesen H, Amarenco P, Hennerici MG, Callahan A, Goldstein LB, Zivin J, et al. : Atorvastatin reduces the risk of cardiovascular events in patients with carotid atherosclerosis : a secondary analysis of the stroke prevention by aggressive reduction in cholesterol levels (SPARCL) trial. Stroke 39 : 3297-3302, 2008 https://doi.org/10.1161/STROKEAHA.108.516450
  15. SSYLVIA study investigators : Stenting of symptomatic atherosclerotic lesions in the vertebral or intracranial arteries (SSYLVIA) : study results. Stroke 35 : 1388-1392, 2004 https://doi.org/10.1161/01.STR.0000128708.86762.d6
  16. The EC/IC Bypass Study Group : Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 313 : 1191-1200, 1985 https://doi.org/10.1056/NEJM198511073131904
  17. Wakhloo A, Mandell J, Gounis M, Brooks C, Linfante I, Winer J, et al. : Stent-assisted reconstructive endovascular repair of cranial fusiform atherosclerotic and dissecting aneurysms long-term clinical and angiographic follow-up. Stroke 39 : 3288-3296, 2008 https://doi.org/10.1161/STROKEAHA.107.512996

Cited by

  1. In-Stent Stenosis of Stent-Assisted Coil Embolization of the Supraclinoid Internal Carotid Artery Aneurysm vol.51, pp.6, 2010, https://doi.org/10.3340/jkns.2012.51.6.370
  2. Analysis of Closed-Cell Intracranial Stent Characteristics Using Cone-Beam Computed Tomography With Contrast Material vol.53, pp.6, 2010, https://doi.org/10.2176/nmc.53.403
  3. Stent-assisted treatment of unruptured and ruptured intracranial aneurysms: clinical and angiographic outcome vol.27, pp.5, 2013, https://doi.org/10.3109/02688697.2012.757292
  4. Safety and Efficacy of Neuroform for Treatment of Intracranial Aneurysms: A Prospective, Consecutive, French Multicentric Study vol.34, pp.6, 2013, https://doi.org/10.3174/ajnr.a3379
  5. Use of stent-assisted coil embolization for the treatment of wide-necked aneurysms: A systematic review vol.4, pp.None, 2013, https://doi.org/10.4103/2152-7806.109810
  6. Disappearance of a small intracranial aneurysm as a result of vessel straightening and in-stent stenosis following use of an Enterprise vascular reconstruction device vol.6, pp.1, 2014, https://doi.org/10.1136/neurintsurg-2012-010583.rep
  7. Comparison of Enterprise and Neuroform Stent-Assisted Coil Embolization of Distal Internal Carotid Artery Aneurysms: Midterm Results from a Single-Center Experience vol.70, pp.3, 2010, https://doi.org/10.3348/jksr.2014.70.3.181
  8. Iatrogenic Carotid-Cavernous Fistula after Stent Assisted Coil Embolization of Posterior Communicating Artery Aneurysm vol.17, pp.1, 2010, https://doi.org/10.7461/jcen.2015.17.1.43
  9. Spectral Imaging for Intracranial Stents and Stent Lumen vol.11, pp.1, 2010, https://doi.org/10.1371/journal.pone.0145999
  10. Stent-assisted coiling of intracranial aneurysms using LEO stents: long-term follow-up in 153 patients vol.60, pp.2, 2018, https://doi.org/10.1007/s00234-017-1965-1
  11. Long Term Outcome of In-Stent Stenosis after Stent Assisted Coil Embolization for Cerebral Aneurysm vol.62, pp.5, 2010, https://doi.org/10.3340/jkns.2019.0087