BACKGROUND AND PURPOSE:The Neuroform Atlas is a new microstent to assist coil embolization of intracranial aneurysms that recently gained FDA approval. We present a postmarket multicenter analysis of the Neuroform Atlas stent. MATERIALS AND METHODS:On the basis of retrospective chart review from 11 academic centers, we analyzed patients treated with the Neuroform Atlas after FDA exemption from January 2018 to June 2019. Clinical and radiologic parameters included patient demographics, aneurysm characteristics, stent parameters, complications, and outcomes at discharge and last follow-up. RESULTS:Overall, 128 aneurysms in 128 patients (median age, 62 years) were treated with 138 stents. Risk factors included smoking (59.4%), multiple aneurysms (27.3%), and family history of aneurysms (16.4%). Most patients were treated electively (93.7%), and 8 (6.3%) underwent treatment within 2 weeks of subarachnoid hemorrhage. Previous aneurysm treatment failure was present in 21% of cases. Wide-neck aneurysms (80.5%), small aneurysm size (,7 mm, 76.6%), and bifurcation aneurysm location (basilar apex, 28.9%; anterior communicating artery, 27.3%; and middle cerebral artery bifurcation, 12.5%) were common. A single stent was used in 92.2% of cases, and a single catheter for both stent placement and coiling was used in 59.4% of cases. Technical complications during stent deployment occurred in 4.7% of cases; symptomatic thromboembolic stroke, in 2.3%; and symptomatic hemorrhage, in 0.8%. Favorable Raymond grades (Raymond-Roy occlusion classification) I and II were achieved in 82.9% at discharge and 89.5% at last follow-up. mRS #2 was determined in 96.9% of patients at last follow-up. The immediate Raymond-Roy occlusion classification grade correlated with aneurysm location (P , .0001) and rupture status during treatment (P ¼ .03). CONCLUSIONS:This multicenter analysis provides a real-world safety and efficacy profile for the treatment of intracranial aneurysms with the Neuroform Atlas stent.

SUMMARY:FPCT and navigation software on contemporary fluoroscopic units perform imaging of a quality comparable with conventional CT. They can accurately guide percutaneous procedures, providing live instrument visualization and the capability to re-image without patient transfer. FPCT navigation was used in the placement of a ventricular drain in a 62-year-old woman for subarachnoidrelated hydrocephalus by using an otherwise standard bedside technique. Ventriculostomy catheter placement was technically successful without complication with a catheter at the foramen of Monro.ABBREVIATIONS: DSA ϭ digital subtraction angiography; FPCT ϭ flat panel detector CT F PCT and integrated guidance software available on contemporary fluoroscopic systems emit a lower radiation dose while producing imaging of a quality comparable with that of conventional CT.1-5 They also have the ability to perform percutaneous procedures within the body, spine, and head and neck safely and accurately.4-11 FPCT demonstrates excellent spatial resolution and, though limited in subtle contrast differentiation, is of diagnostic accuracy in the assessment of general cerebral anatomy and higher attenuation features such as hemorrhage. [5][6][7][8]10,11 Beyond the ability of FPCTbased navigation to quickly and accurately target a particular focus is the provision of real-time instrument visualization using live fluoroscopic overlay and the capability of re-imaging without moving the patient, limitations of current neuronavigational programs. 10Ventricular drain catheter placement in the setting of subarachnoid hemorrhageϪrelated hydrocephalus is a common neurosurgical procedure. Performed at the bedside by using anatomic landmarks, ventriculostomy placement is safe and accurate with a low rate of complications.12-15 Given the frequent need for ventricular drain placement and the relative technical ease of the procedure, we chose it as means to demonstrate proof of principle regarding transcranial FPCT guidance. We herein describe the use of the navigation system in the placement of a ventriculostomy catheter. Case ReportA 62-year-old woman presented with altered mental status. Physical examination revealed an intubated obtunded patient with left-sided hemiplegia and equal and reactive pupils. CT of the head showed diffuse subarachnoid hemorrhage, hydrocephalus, and significant hemorrhage in the basal cisterns. CT angiography revealed a 6 ϫ 7 mm right-sided posterior communicating artery aneurysm and a 3 ϫ 2 mm left-sided middle cerebral artery aneurysm.The patient underwent emergent FPCT-guided ventriculostomy placement in the angiography suite. To minimize movement, we carefully taped her head to the table. The left scalp was prepped, and a 1-cm incision was made at the Kocher point, approximately 11 cm posterior to the glabella and 3 cm lateral to midline in the midpupillary line. A twist-drill craniostomy was performed. The dura and pia mater were cauterized and incised.Before catheter placement, an FPCT (XperCT and XperGuide; Philips Healthcare,...