Walter Casagrande MD. Sections of Cerebrovascular Surgery And Endovascular Neurosurgery

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 !!!