Article Figures & Data
Figures
- Fig 1.
The Willis covered stent. A, The covered stent is attached to the balloon catheter, with the arrows demonstrating the 2 ends of the covered stent. The diameter of the entire system is 3.8F (1.27 mm) when it is not expanded. B, The covered stent is expanded completely against the wall of the model glass tube similar to the siphon segment of the internal carotid artery (arrows).
- Fig 2.
Case 8, a 11-year-old boy with a pseudoaneurysm secondary to a traumatic internal carotid artery. A,B, Anteroposterior and lateral cerebral angiograms show a narrow-necked pseudoaneurysm on the right C7 segment (arrow), with the stenosis of the parent artery. C, A plain film after stent placement clearly shows the position of the covered stent (arrow). D,E, Anteroposterior and lateral cerebral angiograms show complete resolution of the aneurysm immediately after stent placement, with obliteration of the stenosis of the parent artery.
- Fig 3.
Case 6, a 23-year-old man with a pseudoaneurysm secondary to post-balloon embolization of a CCF. A, Lateral cerebral angiogram reveals a wide-necked pseudoaneurysm (black arrow) on the left C4 segment, with stenosis at the proximal part of the parent artery (empty arrow). B, Plain film after stent placement clearly shows the covered stent bridging the pseudoaneurysm and the stenosis (arrows). C, Lateral cerebral angiogram shows complete resolution of the aneurysm immediately after the stent placement. D, Cerebral angiography 3 months after the procedure shows total obliteration of the aneurysm with patency of the parent artery.
- Fig 4.
Case 5, a 35-year-old man with massive epistaxis. A, Lateral cerebral angiogram shows a giant pseudoaneurysm on the left C5 segment (arrow). B, The Willis covered stent can be clearly seen in the plain film (arrows) after stent placement. C, Cerebral angiogram immediately after stent placement demonstrates a minimal endoleak into the pseudoaneurysm (arrow) in the orifice of the ophthalmic artery (arrow). D, Follow-up cerebral angiogram 2 months after the procedure demonstrates that retention of contrast medium at the orifice of the ophthalmic artery is increased (arrow), which suggests the existence of a residual cavity. E, Follow-up cerebral angiogram 6 months after the procedure demonstrates obvious shrinkage of the residual cavity (arrow) with patency of the parent artery.
Tables
Summary of eight patients with intracranial pseudoaneurysms treated with the Willis covered stent
Case No./Age /Sex Presenting Symptoms Cause Aneurysm Location Aneurysm Size (mm) Stent Size (mm) Resistance Reaching Target Lesion Immediate Angiography, Poststenting Follow-Up (mos) Follow-Up Angiography Clinical Outcome 1/48/M Headache, diplopia, decreased visual acuity Post-balloon occlusion of CCF Right C3 10 × 8 4 × 10 None PA resolution, parent artery patency 12 PA resolution, parent artery patency Improvement 2/38/M Left eye blindness Trauma Left C4 15 × 12 4 × 10 No apparent resistance PA resolution, parent artery patency 5 PA resolution, parent artery patency Unchanged 3/34/M Palsy Post-balloon occlusion of CCF Right C4 15 × 12 5 × 13 None PA resolution, small CCF 6 PA resolution, CCF alleviation Improvement 4/50/M Palsy Post-balloon occlusion of CCF Right C4 23 × 16 4 × 13 None PA resolution, parent artery patency 6 PA resolution, parent artery patency Full recovery 5/35/M Epistaxis Trauma Left C5 22 × 18 4 × 10 None Minimal endoleak into PA, parent artery patency 6 Residual cavity shrinkage, parent artery patency Full recovery 6/23/M No symptoms Post-balloon occlusion of CCF Left C4 15 × 12 4 × 13 None PA resolution, parent artery patency 3 PA resolution, parent artery patency Full recovery 7/60/M Headache, Ptosis Trauma Left C6 30 × 15 3.5 × 13 3.5 × 10 None Minimal endoleak into PA, parent artery patency 3 Residual cavity shrinkage, parent artery patency Improvement 8/11/M Decreased visual acuity Trauma Right C7 18 × 10 3.5 × 10 None PA resolution, parent artery patency 3 PA resolution, parent artery patency Full recovery Note:—CCF indicates carotid cavernous fistula; PA, pseudoaneurysm.
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