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

Abstract

Background This study analyzed the safety and efficacy of Enterprise 2 stent-assisted coil embolization for wide-necked intracranial aneurysms by examining stent-vessel apposition, operative complications, embolization outcomes, and clinical outcomes. Methods We retrospectively reviewed the medical records of patients with wide-necked intracranial aneurysms who underwent Enterprise 2 stent-assisted coiling in our hospital from November 2018 to October 2019. Intraoperative VasoCT was performed immediately after stent release in a continuous cohort of patients to observe stent-vessel apposition. Patient demographic, clinical, and imaging data were recorded and analyzed. Results A total of 106 wide-necked aneurysms in 106 patients were treated. Stent release was successful in all patients. Twenty-one patients were enrolled consecutively for VasoCT scanning, and incomplete stent apposition was observed in 5 (23.8%). Perioperative complications occurred in 10 patients (9.4%): cerebral infarction in 6, intraoperative coil prolapse in 1, puncture site pseudoaneurysm in 1, deep vein thrombosis at multiple sites in 1, and transient brainstem mass effect in 1. Among the 95 aneurysms with angiographic follow-up, embolization was satisfactory (Raymond–Roy classifications I and II) in 89 (93.7%). Hyperlipidemia was an independent risk factor for incomplete aneurysm occlusion. At the last clinical follow-up, seven patients had a poor clinical outcome (modified Rankin Scale score ≥ 3). Independent risk factors for poor outcomes were preoperative subarachnoid hemorrhage at presentation and cerebral infarction. Conclusion Enterprise 2 stent-assisted coiling for treatment of wide-necked intracranial aneurysms showed good safety and efficacy; however, incomplete stent apposition can still occur in vessels with a large curvature. Preoperative subarachnoid hemorrhage at presentation and cerebral infarction are the main reasons for poor clinical outcomes after stent-assisted coil embolization.

Use of the Neuroform Atlas stent for wide-necked cerebral aneurysms

“…Other stents have also been used in endovascular treatment of wide-necked cerebral aneurysms. The second-generation Enterprise 2 stent (Codman Neurovascular, Miami Lakes, FL, USA) features improved maximal diameter (5.0 mm) and stent strut geometry to reduce the incidence of operative complications by achieving better stent-vessel wall apposition 17 , 18 . In a study investigating the effects of the Enterprise 2 stent in 106 wide-necked aneurysms in 106 patients by Zhou et al 17 , the stent was successfully deployed in all patients, perioperative complications occurred in 10 patients (9.4%) (including cerebral infarction in 6), follow-up angiographic aneurysm occlusion was satisfactory (Raymond grades I and II) in 89 (93.7%), and poor clinical outcome (mRS ≥ 3) at the last follow-up was seen in seven patients.…”

“…The second-generation Enterprise 2 stent (Codman Neurovascular, Miami Lakes, FL, USA) features improved maximal diameter (5.0 mm) and stent strut geometry to reduce the incidence of operative complications by achieving better stent-vessel wall apposition 17 , 18 . In a study investigating the effects of the Enterprise 2 stent in 106 wide-necked aneurysms in 106 patients by Zhou et al 17 , the stent was successfully deployed in all patients, perioperative complications occurred in 10 patients (9.4%) (including cerebral infarction in 6), follow-up angiographic aneurysm occlusion was satisfactory (Raymond grades I and II) in 89 (93.7%), and poor clinical outcome (mRS ≥ 3) at the last follow-up was seen in seven patients. In a study exploring the effect of the Leo Baby stent (Balt Extrusion, Montmorency, France) for assisted coiling in 131 patients with 135 aneurysms 19 , the technical success was achieved in all cases (100%), complete occlusion was obtained in 111 aneurysms (82.2%), neck remnants in 19 (14.1%), and residual sac in 5 (3.7%) immediately after embolization.…”