Solitaire stent for endovascular treatment of intracranial aneurysms: Immediate and mid-term results in 15 patients with 17 aneurysms

Summary

Introduction

The Solitaire stent is the first fully retractable stent for endovascular treatment (EVT) of intracranial aneurysms. The aim of this study was to evaluate its use in a prospective series with mid-term follow-up.

Methods

A retrospective review of our prospectively maintained database identified all patients treated with a Solitaire stent. Clinical charts, procedural data, angiographic results were reviewed.

Results

Between June 2008 and September 2009, 15 patients with 17 wide-necked or fusiform aneurysms (16 unruptured/one ruptured) were identified. EVT was successfully performed in all but one patient in whom the stent was removed because it induced flow reduction in the 1.8-mm parent artery. Among 14 treated patients, 13 had an excellent outcome and one had a good outcome. In this latter patient, the first stent could not be delivered and was changed for another one that was successfully deployed. The patient experienced a thrombo-embolic complication 6 hours after EVT and kept a slight hand paresis. In all cases but one, the stent was thus easily navigated and positioned despite a relative poor visibility. Angiographic results included eight complete occlusions, two neck remnants, and six incomplete occlusions. Six-month control in 14 aneurysms showed 13 complete occlusions and one incomplete occlusion.

Conclusion

The Solitaire stent is useful for EVT of complex intracranial aneurysms because it is fully retractable, easy to navigate and to precisely place. However, it should be used with caution in arteries less than 2 mm in diameter.

Introduction

Endovascular treatment (EVT) by means of detachable coils is more and more considered as first-intention treatment for both ruptured and unruptured intracranial aneurysms (IA) [1], [2], [3], [4], [5], [6], [7], [8]. However, in case of wide-necked or fusiform aneurysms, selective embolization remains difficult because of the risk of coil protrusion within the parent vessel. Wide-necked aneurysms may be treated by the use of the “remodeling technique”: a small balloon-occlusion microcatheter is used to protect the parent artery lumen during coils deployment within the lesion. However, this technique may fail to retain coils within the sac in aneurysms with a very large neck. Recently, several authors have shown the safety and efficacy of stent-assisted coiling for EVT of such complex aneurysms [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23]. Among available self-expandable stents, the Solitaire stent (EV3, Irvine, CA) is the most recent one and few information is available concerning the advantages of this stent as well as its potential limitations [13], [14], [23]. The aim of this study was to report clinical outcome and mid-term angiographic follow-up of 15 patients with 17 aneurysms treated with the Solitaire stent.