Bare Stent-Graft Technique: A New Method of Endoluminal Vascular Reconstruction for the Treatment of Giant and Fusiform Aneurysms
Civan Islaka,
Naci Kocera,
Sait Albayrama,
Osman Kizilkilica,
Omer Uzmaa and
Oktay Cokyuksela
a From the Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical School, Istanbul University, Turkey
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FIG 1. Case 1. Initial anteroposterior arteriograms in a 44-year-old woman who presented with SAH.
A, Image obtained with a left vertebral arterial injection shows a giant fusiform aneurysm that extends over the vertebrobasilar junction up to the midbasilar level.
B, Image obtained with a right vertebral arterial injection shows another fusiform aneurysm in the V4 segment of right vertebral artery a just before the the origin of the PICA. Note hypoplasia of distal V4 segment of right vertebral artery.
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FIG 2. Case 1.
A, Illustration of bare stent placement.
B, Corresponding angiographic image.
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FIG 3. Case 1.
A, Illustration of stent graft positioning.
B, Corresponding angiographic image.
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FIG 4. Case 1.
A, Illustration of the deployed stent graft. Note the peripheral thrombosis of the aneurysm (shaded area).
B, Angiogram obtained immediate after graft stent placement angiogram shows total occlusion of the inflow to the aneurysm and an absence of turbulent flow in the aneurysmal sac. Both of the AICAs are patent, and both of the PCA regions are filling normally.
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FIG 5. Case 1.
A, Control angiogram obtained at 4-month follow-up reveals the progression of thrombosis and the disappearance of the giant fusiform aneurysm.
B, Four consecutive T2-weighted (4600/100/2 [TR/TE/NEX]) axial MR images obtained at the level of the brain stem show normal findings rather than compression of the thrombosed aneurysm.
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FIG 6. Case 2. A 59-year-old woman was admitted to the hospital with an acute-onset severe headache.
A, Anteroposterior arteriogram obtained with a left carotid arterial injection shows a giant wide-necked aneurysm in the paraophtalmic segment of the left ICA.
B, Oblique angiogram shows stent graft placement into an already deployed bare stent.
C and D, Control anteroposterior (C) and oblique (D) arteriograms obtained immediately after the procedure reveal total exclusion of the giant aneurysm.
E, Oblique arteriogram obtained with a left carotid arterial injection 4 months after the procedure shows slight intimal hyperplasia at the proximal edge. The narrowing appears to be less than 50%.
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AJNR - American Journal of Neuroradiology