COMBINED STENT IMPLANTATION AND ENDOSACCULAR COIL PLACEMENT FOR TREATMENT OF EXPERIMENTAL WIDE-NECKED ANEURYSMS - A FEASIBILITY STUDY IN SWINE

PURPOSE: To assess the feasibility of combining stent implantation in the parent artery with endosaccular coil placement for the treatment o f experimentally created wide-necked aneurysms. METHODS: Wide-necked a neurysms were surgically created on the common carotid artery in 12 sw ine. A metal stent was endovascularly implanted across each aneurysm n eck and its effect documented anigiographically. If the aneurysm remai ned patent, a microcatheter was introduced into the aneurysm through t he stent mesh. Electrically detachable coils were delivered into the a neurysm sac to produce thrombosis. RESULTS: After stent implantation, one carotid artery thrombosed and two aneurysms spontaneously occluded . In the other 9 cases, coils were deposited through the stent to occl ude the aneurysm. Complete aneurysm packing was possible in all 9 case s. The presence of the stent allowed placement of small coils near the aneurysm neck, thus contributing to the safe occlusion of small remna nts in the final stages of aneurysm packing. CONCLUSION: The combinati on of stent implantation and coil placement is feasible in the treatme nt of experimental wide-necked saccular aneurysms. The stent maintains patency of the parent artery while allowing aneurysm occlusion by end osaccular coil placement through the stent's mesh. Occlusion of small aneurysm remnants is possible with no fear of coil hernation or migrat ion into the parent artery. Long-term studies will be necessary before application to treatment of selected intracranial aneurysms.