Flow-diverter stent

Flow-diverter stents are important devices in the management of intracranial aneurysms in both acute and elective settings, especially ones that are large, broad-necked, or fusiform.

Complications

Understanding the complication rates is important in obtaining informed consent from patients. In general, the rate of permanent morbidity is 3.7% and mortality 2.8%, as reported by a meta-analysis ⁹. Ruptured aneurysms and aneurysms at the posterior circulation are associated with a higher rate of complications ⁹. Other specific complications include:

• intra-operative rupture (~2%)

• delayed aneurysm rupture (~1%)

• thromboembolic event (~5%), patients usually need a period of antiplatelet therapy to mitigate the risk

• side branch occlusions, such as ophthalmic artery and anterior choroidal artery

• peri-aneurysmal edema, that is extension of the inflammatory process accompanying aneurysm thrombosis causing adjacent cerebral edema

• non-ischemic cerebral enhancing (NICE) lesions (~1%) ⁷

• delayed intraparenchymal hemorrhage (DIPH) ⁸

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.