Flow-diverter stents are relatively new and important devices in the management of intracranial aneurysms, especially ones that are large, broad-necked or fusiform.
In a multi-center study in Italy, Briganti et al. reported an overall morbidity rate of 3.7% and a mortality rate of 5.9. The mentioned complications in the literature include:
- side branch occlusion, such as ophthalmic artery and anterior choroidal artery
- in-stent thrombosis
- delayed hemorrhage, both parenchymal and subarachnoid
- peri-aneurysmal edema, that is extension of the inflammatory process accompanying aneurysm thrombosis causing adjacent cerebral edema
History and etymology
Somewhat surprisingly the word 'stent' is actually an eponym, originally named after Charles Stent (1807-1885), a largely-forgotten British dentist. He invented an improved material for forming dental impressions, and set up a company to manufacture it. During the Great War, J F Esser, a Dutch surgeon used a mold of Stent's Compound as a fixative for skin grafting in injured infantrymen. This innovative use, was rapidly adopted into practice, and stenting as a concept rapidly segued into multiple specialties 6.
- 1. D'Urso PI, Lanzino G, Cloft HJ et-al. Flow diversion for intracranial aneurysms: a review. Stroke. 2011;42 (8): 2363-8. doi:10.1161/STROKEAHA.111.620328 - Pubmed citation
- 2. Berge J, Biondi A, Machi P et-al. Flow-diverter silk stent for the treatment of intracranial aneurysms: 1-year follow-up in a multicenter study. AJNR Am J Neuroradiol. 2012;33 (6): 1150-5. doi:10.3174/ajnr.A2907 - Pubmed citation
- 3. Piano M, Valvassori L, Quilici L et-al. Midterm and long-term follow-up of cerebral aneurysms treated with flow diverter devices: a single-center experience. J. Neurosurg. 2013;118 (2): 408-16. doi:10.3171/2012.10.JNS112222 - Pubmed citation
- 4. Briganti F, Napoli M, Tortora F et-al. Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications-a retrospective data analysis. Neuroradiology. 2012;54 (10): 1145-52. doi:10.1007/s00234-012-1047-3 - Pubmed citation
- 5. Alderazi YJ, Shastri D, Kass-Hout T et-al. Flow diverters for intracranial aneurysms. Stroke Res Treat. 20;2014: 415653. doi:10.1155/2014/415653 - Free text at pubmed - Pubmed citation
- 6. Stenting. (2001) Surgical Endoscopy. 15 (4): 423. doi:10.1007/s004640080116 - Pubmed