Clinical Safety and Effectiveness of Stent-Assisted Coil Embolization with Neuroform Atlas Stent in Intracranial Aneurysm

Abstract

Stent-assisted coil embolization (SAC) is commonly used for treating wide-neck intracranial aneurysms. In this study, we aimed to assess the clinical safety and efficacy of the NeuroForm Atlas Stent during SAC of intracranial aneurysms. Methods : We retrospectively analyzed data from patients with ruptured and unruptured cerebral aneurysms, who underwent SAC using the NeuroForm Atlas between February 2018 and July 2018. Favorable clinical outcomes and degree of aneurysm occlusion were defined as a modified Rankin scale score of ≤2 and a Raymond-Roy occlusion classification (RROC) class I/II during the immediate postoperative period and at the 6-month follow-up, respectively. Results : Thirty-one consecutive patients with 33 cases, including 11 ruptured and 22 unruptured cases were treated via NeuroForm Atlas SAC. Among the 22 unruptured cases with 24 unruptured aneurysms had favorable clinical outcome. Complete occlusion (RROC I) was achieved in 16 aneurysms (66.7%), while neck remnants (RROC II) were observed in six aneurysms (25%). Among the 11 patients with ruptured aneurysms, two died due to re-bleeding and diabetic ketoacidosis. In ruptured cases, RROC I was observed in eight (72.7%) and RROC II was observed in three cases (27.3%). At the 6-month follow-up, no clinical events were observed in the 22 unruptured cases. In the ruptured nine cases, five patients recovered without neurologic deficits, while four experienced unfavorable outcomes at 6 months. Of the 29 aneurysms examined via angiography at the 6-month follow-up, 19 (65.5%) were RROC I, eight (27.6%) were RROC II and two (6.9%) were RROC III. There were no procedure-related hemorrhagic complications. Conclusion : In this study, we found that stent-assisted coil embolization with NeuroForm Atlas stent may be safe and effective in the treatment of wide-neck intracranial aneurysms. NeuroForm Atlas SAC is feasible for the treatment of both ruptured and unruptured wide-neck aneurysms.

Safety of stent-assisted coiling for the treatment of wide-necked ruptured aneurysm: A systematic literature review and meta-analysis of prevalence

“…Non-specific thromboembolic events were the most common thromboembolic complication while intra-procedure re-rupture was the most common hemorrhagic complication. 13 Retrospective 2010 42 0.7 Gao et al 14 Retrospective 2011 232 1.0 Kung et al 15 Retrospective 2011 131 0.8 Lodi et al 16 Retrospective 2011 22 0.7 Amenta et al 17 Retrospective 2012 65 0.8 Golshani et al 18 Retrospective 2012 36 0.8 Alurkar et al 18 Retrospective 2012 42 0.8 Santillan et al 19 Retrospective 2012 20 0.6 Li et al 20 Retrospective 2013 19 0.6 Giyek et al 21 Retrospective 2013 70 0.9 Chung et al 22 Retrospective 2014 72 0.8 Bechan et al 23 Prospective 2015 45 0.9 Li et al 24 Retrospective 2015 38 0.7 Yang et al 25 Retrospective 2015 211 0.8 Cai et al 26 Retrospective 2016 65 0.8 Zhao et al 27 Retrospective 2016 23 1.0 Muto et al 28 Retrospective 2016 40 0.7 Liu et al 29 Retrospective 2016 218 0.9 Liu et al 30 Retrospective 2017 113 0.9 Ho et al 31 Retrospective 2018 29 0.8 Zuo et al 32 Retrospective 2018 133 1.0 Roh et al 33 Retrospective 2019 38 0.8 Kim et al 34 Retrospective 2019 11 0.7 *Each article was assigned a quality score to stratify them based on risk of heterogeneity, 0 being high risk and 1 being low risk. Other hemorrhagic complications: 14 (9.5%) Infarction: 7 (4.6%)…”

Outcomes of Stent-Assisted Coiling Using the Neuroform Atlas Stent in Unruptured Wide-Necked Intracranial Aneurysms

“…There have been a few reports on SAC with Neuroform Atlas stents, of which most have reported that SAC using Neuroform Atlas stents is safe and effective in treating wide-necked aneurysms [ 1 , 6 , 7 , 13 , 14 ]. From their experience with 27 consecutive patients, the authors of one study concluded that Neuroform Atlas SAC is feasible for treating ruptured and unruptured wide-necked aneurysms that are not amenable to conventional coiling or clipping [ 13 ].…”

“…Although SAC using the Neuroform Atlas stent has been reported to be safe and effective in treating wide-necked aneurysms [ 1 , 6 , 7 , 13 , 14 ], the technique has procedure-related complications that interventionists need to understand completely. However, none of those studies reported the incidence of and risk factors for procedure-related complications.…”

Multi-centric European post-market follow-up study of the Neuroform Atlas Stent System: primary results

“…Initial experiences consisting of mostly retrospective and single centered investigations were published, but limitations were noted due to their study designs and a lack of patients or follow-up. [3][4][5][6][7][8][9][10][11][12][13] We therefore conducted a prospective and multicentric post-market study to determine the clinical and technical outcomes following treatment of intracranial aneurysms with the Neuroform Atlas stent.…”