Walter Casagrande MD.Sections of Cerebrovascular Surgery
And Endovascular NeurosurgeryHospital Juan A. Fernandez
Buenos Aires, Argentina
Travel Stories: An Argentinian Story
Acknowledgement
Rosario Dr. Sergio Petrocelli Dr. Juan Godes
Córdoba Dr. Gustavo Foa Torres Dr. Federico Roca
Tucumán Dr. Roberto Gonzalez
Buenos Aires Dr. Gustavo Mazenga
Dra. Silvia Garbugino Dr. Luis Lemme-Plaghos
Clinical Characteristics
Incidental 7 (19,4%)Treated Previously 7 (19,4%)Mass Effect 18 (50%)Previous Subaracnoid Hemorrhage 4 (11,2%)
24 months study period (June/08 - June/10)36 Total aneurysms treated
Morphological Characteristics
Wide Neck 9 (25%)Large 6 (16,7%)Giant 8 (22,2%)Non Saccular 8 (22,2%)Recurrent 5 (13,9%)
Immediate FU
Wide Neck- Incidental
Wide Neck- Incidental
6 mounths FU
Giant-Mass Effect
Pre-treatment
Post-treatment
Giant-Mass Effect
Giant-Mass Effect
6 mounths FU
MRI August 08 MRI September 09
Giant-Mass Effect
Recurrent Aneurysm
Recurrent Aneurysms
6 mounths FU
Recurrent Aneurysm
Non Saccular Aneurysm
Non Saccular
Leo + 3,5 x 50
Silk 5 x 50
Limitations
Vascular Morphology
Progression inside the vessels
Silk 4,5 x 25
Limitations
Morphology of Aneurysm
Limitations
Limitations = Challenges
Dr. Juan GodesDr. Sergio Petrocelli
Pre-treatment 4 months FUwith Clopidogrel
Limitations = Challenges
Complications
3 Carotid Oclutions (2 reopend after 24Hs.)
1 Stent Migration (Neurological Deficit) (2,7%)
Limitations = Challenges
Results
Mass Effect diminished 16 (n18) (89%)Neurological Deficit 1 (2,7%)Hemorrhage (0%)Death 1 (Pneumonia) (2,7%)
CLINICAL FOLLOW UP
Angiographic Results
4M.(n31) 12M.(n10) 24M.(n8)
Ocl. 10% 1 (3,2%) 1 (10%)
Ocl.85-90% 17 (54,9%) 2 (20%) 1 (12,5%)
Ocl.100% 13 (41,9%) 7 (70%) 7 (87,5%)
Conclusions
Silk Stent induces “endovascular reconstruction”
• Rebuilds arterial wall in wide neck and fusiform aneurysms • Effectively reduces mass effect • Prevents rebleeding• Long-Term durability of occlusions
TANTIE GRAZIE !!!