Article Figures & Data
Figures
- Fig 1.
Photograph of the Willis covered stent with complete expansion and deployment.
- Fig 2.
Case 8, a 33-year-old woman with acute subarachnoid hemorrhage. A, Cerebral angiogram revealed a wide-necked aneurysm (arrow) at the origin of the posterior communicating artery (PcomA) and an infundibulum at the origin of AchoA (arrowhead) on the left ICA, respectively. B, The angiogram immediately after balloon-assisted coil embolization showed a subtotal occlusion of aneurysm. C, Recurrence of aneurysm was demonstrated on follow-up angiogram 3 months after coiling (arrow). D–F, Plain film showed the covered stent in place before balloon inflation (arrows), during balloon inflation (arrows), and deployment without balloon inflation (arrows), respectively. G, (slight oblique projection) and F, (lateral projection), Complete disappearance of aneurysm and excellent patency of AchoA (arrows) was shown by immediate angiogram after covered stent placement.
- Fig 3.
Case 2, a 48-year-old man with a pseudoaneurysm, secondary to postballoon embolization of a carotid cavernous fistula. A, Lateral cerebral angiogram reveals a large pseudoaneurysm (arrow) on the right C3 segment of the ICA at 3 months of angiographic follow-up after balloon embolization. B, The immediate angiogram after coil embolization revealed near total occlusion of the aneurysm. C, The recurrence of aneurysm (arrow) was demonstrated on the 3-month follow-up angiogram after coiling. D, The recurrent aneurysm cavity was totally occluded after the placement of a 4- × 10-mm Willis covered stent. E and F, 3- and 12-month follow-up angiograms showed complete disappearance of aneurysm and excellent patency of the parent artery.
- Fig 4.
Case 6, a 51-year-old man with acute subarachnoid hemorrhage. A, Anteroposterior cerebral angiogram revealed a dissecting aneurysm (arrow) on the right V4 of the VA. B, Plain film showed balloon-in-stent technique for the coil embolization of aneurysm. C, Immediate cerebral angiogram after coiling revealed subtotal occlusion of the aneurysm (arrow). D, 3-month follow-up angiogram after coiling demonstrated enlargement of the residual aneurysm cavity (arrow). E, Plain film showed deployment of the covered stent after balloon inflation (arrows). F, Total occlusion of the aneurysm sac and excellent patency of the parent artery was shown by immediate angiogram after covered stent placement. G, 3-month follow-up angiogram revealed the disappearance of aneurysm, with mild dilation of parent artery (arrows); this patient was still under close follow-up.
Tables
Summary of treatment with Willis covered stent in 8 patients with recurrent aneurysm after coiling
Case No. Age, y/ gender Type of Aneurysm Aneurysm Size/Recurrent sac/Neck, mm Location Residual Neurologic Symptoms Result of Initial Coiling Type of Recurrence Covered Stent, mm Immediate Angiographic Result Angiographic Follow-Up Result/Period, mo Neurologic Follow-Up Result/Period, mo 1† 39/M Giant/saccular 26/11/6 R/C7 Diplopia and right eyesight degradation Partial Enlargement of residual sac 3.5 × 10, 4 × 7, 4 × 7 Good Disappearance of AN, patency of PA/16 Fully recovered/30 2‡ 48/M Large/pseudo 18/10/5 R/C3 III, IV, VI nerve paralysis, diplopia, and tinnitus Total/near total Reopen 4 × 10 Excellent Disappearance of AN, patency of PA/12 Improved/30 3 38/M Giant/pseudo 25/10/4 L/C7 Left eyesight loss Partial Enlargement of residual sac 4 × 10 Excellent Disappearance of AN, patency of PA/12 Unchanged/27 4 49/F Small/saccular 5/2/3 L/C7 None Subtotal Enlargement of residual sac 4 × 10 Excellent Disappearance of AN, stenosis of PA/6 Unchanged/25 5 49/F Small/saccular 3/2/2 R/C7 Repeated headache Total/near total Reopen 4 × 7 Good Disappearance of AN, patency of PA/12 Fully recovered/20 6* 51/M Middle/dissecting 8/15/10 R/V4 Intermittent headache Subtotal Enlargement of residual sac 4 × 13, 4 × 16 Excellent Disappearance of AN, patency of PA/3 Fully recovered/6 7 42/F Giant/saccular 28/10/5 R/C4 Diplopia Total/near total Reopen 3.5 × 7 Excellent Disappearance of AN, patency of PA/1 Fully recovered/1 8 33/F Small/saccular 5/3/2 L/C7 Headache Subtotal Enlargement of residual sac 3.5 × 7 Excellent Disappearance of AN, patency of PA/1 Fully recovered/1 Note:—The classification of internal carotid artery is based on the Bouthillier segment. Pseudo indicates pseudoaneurysm; Total/near total, occlusion rate from 95% to 100%; Subtotal, occlusion rate from 80% to 95%; Partial, occlusion rate less than 80%; AN, aneurysm; PA, parent artery; R, right; L, left.
* More than 1 stent was used to cover the orifice of aneurysm.
† The information in Case 1 was used in Neuroradiology.24
‡ The information in Case 2 was used in Neuroradiology.21,24
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