Using a covered stent for large cerebral aneurysms treated with stent-assisted coiling

Purpose: The purpose of this article is to evaluate the efficacy and safety of covered stent implantation for large intracranial aneurysms treated with stent-assisted coiling.

Materials and methods: Seven patients with a cerebral aneurysm were selected for this study. The aneurysms were located at the cavernous segment of the internal carotid artery in three cases, the supraclinoid segment in two and the vertebrobasilar junction in one. Aneurysm diameter was 10-25 mm. Mass effect symptoms occurred in six patients, epistaxis in one and subarachnoid hemorrhage in one. All patients underwent endovascular reconstruction with stent-assisted coiling and a covered stent. Five had undergone conventional endovascular embolization with stent-assisted coiling three to six months previously; the covered stent was then navigated through the existing stent and deployed to cover the aneurysm neck. In two cases, the covered stent was deployed after stent-assisted coiling in a single procedure.

Results: Angiography showed that all aneurysms were excluded from the circulation and parent arteries were preserved. No technical adverse events occurred. At the one- to two-year follow-up, complete resolution of clinical symptom had occurred in six patients and partial resolution in one. No recurrent aneurysm filling and no hemodynamic stenosis was observed.

Conclusion: Endovascular reconstruction combining a covered stent with stent-assisted coiling could be an effective and safe strategy for the treatment of large cerebral aneurysms.