Stent Graft Treatment of Cerebrovascular Wall Defects: Intermediate-term Clinical and Angiographic Results

OBJECTIVE: Endovascular stent graft (SG) deployment offers a useful vesel-preserving strategy for vscular wall lesions such as pseudoaneurysms and fistulac. Although deployment of expanded polytetrafluoro-ethylene-covered SGs within the carotid and vertebral arteries is technically feasible, data on long-term efficacy, safety, and patency METHODS Six patients with traumatic (n=4), introgenic (n=1), or spontaneous (n=1) internal carotid and vertebral artery injuries direct carotid-cavernous fistula, n=2; pseudonneurysms, n=4) were treated with nine balloon-mounted coronary expanded polytetrafluoro-ethylene SGs. Angiographie (mean, 2,3 in tange 1,7 4,2 yr) and neurological follow-up (mean, 2.7 yr) was performed for all patients. RESULTS: Complete angiographic exclusion of the lesion was achieved by the initial procedure in five of the six patients; one ruptured cavemous carotid neurysm leading to a direct carotid-cavernous fistula showed persistent slow shunting despite fandem deployment of two SGs. All six patients revenled complete and persistent angiographic obliteration at delayed follow-up, with minimal in-stent stenosis (<20%) seen in two instances. Difficulty with SG navigation was encountered in five patients, resulting in one instance of guide catheter-induced intimal dissection. Type I endoleak was observed in five patients, requiring secondary angioplasty in four patient and deployment of an additional tandem SG in three. CONCLUSION: Technical challenges in current generation SG deployment include sizing, navigation, positioning; and propensily for endoleak. When managed success-fully, stent grafting provides a valuable approach for the treatment of defects for which vessel preservation is preferred. Intermediate. tory, with no delayed complications and mimmal in-stent stenosis in follow-up periods of more than 2 years.