Comparative outcome analysis of enterprise and neuroform stent-assisted coiling of cerebral aneurysms: A review of the literature

Abstract

Introduction: One of the popular treatment strategies for complex cerebral aneurysms with wide necks or low dome-to-neck ratios is stent-assisted coiling. The most widely used intracranial stents for stent-assisted coiling are Neuroform (NF) and Enterprise (EP) stents. The purposes of this study are to review the recent literature of the past 5 years to compare outcomes between the EP and NF stent-assist coiling systems so as to comment on the safety, efficacy, complications, and recurrence rate of stent-assisted coiling in general. Methods: PubMed was used to search for all published literature of NF or EP stent-assisted coiling of unruptured cerebral aneurysms from January 2014 to August 2019 with the search terms of “Enterprise stent-assisted coiling,” “Neuroform stent,” and “Neuroform vs. Enterprise stent.” Results: Twenty two publications met the inclusion criteria which encompass 1764 patients and 1873 aneurysms. Out of these 1873 aneurysms, 1007 aneurysms were treated with EP stent and 866 aneurysms were treated with NF stent. The overall outcome was low rates of thromboembolic complications (4.37%) and intracranial hemorrhage (1.13%), low permanent morbidity (1.70%) and mortality (0.40%), and lower rate of recanalization (11%). Data analysis shows an overall higher rate of complication and recurrence of aneurysm and lower overall rate of aneurysmal occlusion in the patients where EP stent was used in comparison to NF stent. However, this difference was not statistically significant. Conclusions: The review of two stent-assisted coiling devices using EP and NF stents including 1873 aneurysms in 1764 patients revealed that overall, it is safe and effective with comparable outcomes.

Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up

“…In one case (5.9%) the stent did not open completely proximally, but this feature is also observed for other well-known brain stents and can be corrected in most clinical cases [3,[11][12][13][22][23][24]. The incidence of technical and clinical complications is similar to other braided stents [3,[22][23][24][25]. No procedure-related stroke occurred in our series, but this observation may be ascribed to the patient group being relatively small.…”

“…Therefore, we recommend the jailing technique with the Accero stents. In one case (5.9%) the stent did not open completely proximally, but this feature is also observed for other well-known brain stents and can be corrected in most clinical cases [3,[11][12][13][22][23][24]. The incidence of technical and clinical complications is similar to other braided stents [3,[22][23][24][25].…”

“…However, these complications may depend on the type of stent and must be checked on a larger group. Also, other various complications were reported, depending on the type of stent used [ 3 , 11 , 12 , 13 , 22 , 23 , 24 , 25 , 26 ]. The metal coverage of the Accero stent depends on the size of the implanted stent and parent vessel diameter to 19%.…”

Effects of Enterprise 2 stent-assisted coil embolization for wide-necked intracranial aneurysms

“…Another study of EP-stent assisted coiling by Mocco et al [ 16 ] reported a 3% rate of stent-related stenosis or occlusion. A meta-analysis of 1007 aneurysms in 915 patients treated with the EP stent reported incidences of thrombotic events and intraoperative rupture of 4.9% and 1.2%, respectively, with satisfactory embolization results in 85.45% of aneurysms [ 5 ]. In our study, 93.7% of aneurysms were finally completely or nearly completely embolized, which was better than the results reported in the abovementioned previous studies, indicating that the modified structure made the EP2 stent superior to the EP stent.…”

Low-profile visualized intraluminal support Blue stenting within a Neuroform Atlas stent for a large wide-necked aneurysm: A case report and a bench-top experiment

“…9,10 Recent studies have shown that the recanalization rate after embolization is lower with Neuroform Atlas than with Enterprise in stent-assisted coil embolization. 11,12 We therefore deployed a Neuroform Atlas at the initial treatment and performed coil embolization with a trans-cell approach.…”