Objectives The Neuroform Atlas stent (AS) is the smallest intracranial stent with an open-cell design. This study reports the first clinical experience with AS. Methods All intracranial aneurysms treated by stent-assisted coiling using a single AS in a single institution were retrospectively evaluated. Patient demographics, aneurysm characteristics, angles between the parent artery and stented branch, technical success, and clinical and angiographic follow-up were analyzed. Results Fifty-five consecutive aneurysms treated with AS-assisted coiling were included. Of these, 69.1% were located distal to the circle of Willis. Technical success rate was 100%. The mean diameters of proximal and distal parent arteries were 2.62 mm (range 1.5–4.4) and 1.8 mm (range 0.8–3.5), respectively. Except for a minor stroke in a patient who completely discontinued antiplatelet therapy on postoperative day 4, there were no clinical events with permanent sequelae, and 94.1% of patients had Raymond-Roy score of 1 or 2 aneurysmal occlusion at a mean follow-up duration of 7.9 months. Although the angle between the parent artery and the stented branch increased significantly ( p < 0.001) with time, the angular change at follow-up was only 16.45 ± 11.03 degrees and was inversely correlated both with preoperative angle and the diameter of the distal parent artery ( r = −0.465 and r = −0.433, respectively, p = 0.004 for both). Conclusion AS-assisted coiling was associated with a favorable early clinical outcome and angiographic results in this series. This stent can be used for distally located aneurysms and results in minimal alteration of the arterial anatomy.

BACKGROUND AND PURPOSE: Carotid near-occlusion has been subclassified into near-occlusion with and without collapse. We aimed to compare the technical success and perioperative complication rates of carotid artery stent placement with special attention to these subtypes to see whether there is a clinical relevance of this subclassification.

Purpose This study evaluated the results of polidocanol sclerotherapy in the treatment of venous malformations (VM) including patient satisfaction, perceived improvement, and predictors of satisfaction. Material and Method Patients with VM that underwent polidocanol foam sclerotherapy between June 2013 and July 2021 in a single center were retrospectively evaluated. Patient demographics, VM, and treatment characteristics were analyzed. Patient-reported outcomes and satisfaction were analyzed with a questionnaire. Results This study included 232 (136, 58.6%, female) patients. The mean age was 24.49 ± 12.45 years (range 3–72). The clinical response rate was 82.3%. The rate of satisfaction was 82.3%, and 116 (50%) patients were significantly satisfied. There were no major complications. Clinical response and VM margin were related to satisfaction ( p < 0.01, p = 0.012, respectively). Clinical response to pretreatment swelling was related to significant satisfaction ( p = 0.02). Conclusion Polidocanol sclerotherapy was safe and effective in VM treatment with high satisfaction and low complication rates.

BACKGROUND AND PURPOSE: Stent bulging technique has been introduced as a technique that improves the outcome of aneurysm coiling. Our aim was to evaluate the utility of this technique, which involves the intentional herniation of stents into the bifurcation aneurysms during coiling.MATERIALS AND METHODS: Unruptured bifurcation aneurysms treated by stent-assisted coiling using a single type of low-profile braided (LEO Baby) stent between November 2012 and October 2018 were retrospectively evaluated. The clinical (age and sex) and morphologic characteristics (aneurysm size, neck size, proximal/distal diameters of the stented artery, incorporation of the origins of the side branches to the aneurysm neck, and bifurcation angle) and response to antiplatelet therapy were evaluated.RESULTS: Sixty-one patients (29 men, 47.5%; mean age, 55. 95 [SD, 12.33] years) with 66 aneurysms were included. There were 36 aneurysms in group A (treated with the stent bulging technique) and 30 aneurysms in group B (treated by classic stent-assisted coiling). There was no significant difference in the patient and aneurysm characteristics in the groups except for the larger size and wider neck of the aneurysms in group A (P ¼ .02 and P ¼ .04, respectively). At the mean follow-up of 27.30 (SD, 17.45) months, there was no significant difference in the complication rate, the occlusion status, and the early and long-term occlusion rates between the groups. The stent bulging technique did not predict total occlusion (Raymond-Roy I) at the final imaging follow-up. CONCLUSIONS:The stent bulging technique enables the coiling of larger, wide-neck aneurysms; however, we did not observe an added flow-diversion effect with the stent bulging technique compared with conventional stent-assisted coiling. We, therefore, suggest that bifurcation aneurysms should be coiled as densely and as safely as possible using this technique.ABBREVIATIONS: ACA ¼ anterior cerebral artery; RDPD ¼ regional diameter percentage difference; RR ¼ Raymond-Roy score; SAC ¼ stent-assisted coiling; SBT ¼ stent bulging technique; SCA ¼ superior cerebellar artery S tent-assisted coiling (SAC) is a safe and effective option in the treatment of wide-neck intracranial aneurysms. The stent provides a scaffold for the neointima formation and prevents coil protrusion into the parent artery. In addition, intracranial stents may result in the development of hemodynamic changes inside the aneurysm, which may lead to further aneurysm occlusion. These hemodynamic changes relate to the type (braided versus laser-cut stents), the number of stents, and the technique of stent deployment. 1,2 In some patients, SAC with a single stent may not provide sufficient neck coverage, and in these cases, dual stent placement in an X or Y configuration may be necessary. Dual stent placement is technically more challenging than basic SAC and is known to be associated with an increased rate of thromboembolic complications. [3][4][5][6] The stent bulging technique (SBT, also known as the shelf technique) has bee...

The SAMMPRIS Trial showed that medical treatment of intracranial stenosis is safer than intracranial angioplasty and stenting (IAS). One of the reasons for the worse outcome with IAS was the occurrence of ipsilateral cerebral hemorrhage, which may be associated with an intracranial exchange maneuver. Newly developed mini intracranial stents may enhance the safety of IAS by obviating the need for this maneuver. We retrospectively evaluated 7 intracranial stenoses (6 patients, 5 men, mean age 57) which were treated with an Atlas stent. In 5 cases there was a high-grade atherosclerotic stenosis which did not optimally respond to medical treatment, one patient had radiotherapy induced stenosis and in one patient there was a chronic arterial dissection with a distal aneurysm. All lesions were located in the petrocavernous segment of the internal carotid artery. All of the procedures were performed electively under dual antiplatelet therapy and general anesthesia. After performing angioplasty of the stenosis with an over-the-wire balloon (e.g. Gateway balloon), the Atlas stent was delivered directly through the lumen of the angioplasty balloon, without a need for an intracranial exchange maneuver.The procedure was successful in all patients. There was no mortality or permanent morbidity related to the procedures. At a mean follow-up of 9.8 months (range 1–18 months ), there was one case of asymptomatic occlusion and otherwise no evidence of restenosis. None of the patients suffered a recurrent ipsilateral stroke.Although further studies are needed for demonstrate safety and efficacy of self-expandable mini stents in IAS, our results indicate that a single step angioplasty/stenting is feasible with these devices. We suggest the optimization of the currently available over-the-wire balloons for this technique.Disclosures F. Cay: None. Y. Senturk: None. A. Peker: None. E. Arsava: None. M. Topcuoglu: None. A. Arat: None.