Stent usage in the treatment of intracranial aneurysms: past, present and future

As endovascular approaches to intracranial aneurysm (IA) treatment continue to evolve, the use of intracranial stents has advanced from an infrequent adjunct to potential curative monotherapy. Early results of endovascular therapy for IAs have clearly underscored large aneurysm size, low coil packing density and wide aneurysm neck as factors limiting successful long term obliteration. Intracranial stents were originally introduced as adjuncts to mitigate these limitations by facilitating tighter coil packing and preventing coil herniation. As evidence of their utility as flow diversion devices and as catalysts for aneurysm neck remodeling surfaced, their potential as standalone therapy was realised and is currently under close scrutiny. Here we review the evolution of stents in the treatment of IAs, from balloon expandable stents, to self-expanding stents, to the exciting advances in monotherapeutic flow diverting stents, amalgamating occlusion rates and reviewing complication rates.