Endovascular Reconstruction Using Covered Stents in Neurosurgery

Objective: to estimate the efficacy of covered stents usage for treatment of various pathology of extra -and intracranial arteries based on our own data. Material and methods: the experience of covered stents usage at 39 patients is presented: 24 cases – cerebral aneurysms of various localization, 13 — carotid-cavernous fistulas (CCFs) of type «А», 2 — arteriovenous (AV) fistulas of V2 segment of vertebral artery. There were 19 women and 20 men. The average age was 36 years old. The follow-up angiographic studies were performed firstly in 6 months after operation. The follow-up varied from 6 till 60 months. Results. The technical success during usage of covered stents was achieved in 84,2% (n=32) cases. The radical elimination of aneurysm from blood flow was seen in 87,5% (n=21) cases. The usage of covered stents for treatment of basilar aneurysms didn’t result in augmentation or appearance of neurological deficit. The treatment outcomes was assessed as 1-2 scores by mRs in 22 patients, lethality was 8,3%. The usage of only covered stent allowed achieving the occlusion of CCF in 69,2% (n=9)cases while in 3 patients the additional usage of coils using venous or combined approach was necessary. The disjunction of CCF with reconstruction of injured ICA was achieved in 12 (92,3%) patients. There was no lethality or postoperative augmentation of neurological deficit in this group. The good clinical and angiographic result was achieved in patients with disjunction of vertebral artery fistulas. Conclusion. The high clinical and economical efficacy of covered stents usage defines the reasonability of their more active appliance for treatment of pathological shunting and aneurismal damages of brain in case of favorable anatomy.