Multicenter Postmarket Analysis of the Neuroform Atlas Stent for Stent-Assisted Coil Embolization of Intracranial Aneurysms

Abstract

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.

Risk Factors for Recurrence of Intracranial Aneurysm After Coil Embolization: A Meta-Analysis

“…These findings may provide some reference for treatment decisions of a multi-disciplinary team. It has been identified that the size of intracranial aneurysms significantly affects the selection and treatment effectiveness of intracranial aneurysms (32)(33)(34)(35). Consistently, our analysis showed that intracranial aneurysms of size > 7 mm have a significantly higher risk of recurrence after coil embolization.…”

Safety and Efficacy of Stent-Assisted Coiling of Unruptured Intracranial Aneurysms Using Low-Profile Stents in Small Parent Arteries

“…[5][6][7] Recently, low-profile stents were introduced to improve the navigability and success rate of the procedure because they can be delivered via 0.0165-or 0.017-inch microcatheters to access tortuous and smaller vessels. [8][9][10] Although the recommended use of the low-profile stents is for a parent artery with a diameter of either $2.0 or $2.5 mm, their off-label use for the treatment of aneurysms arising from smaller parent arteries has become more common. 11,12 However, little is known about the efficacy and safety of SAC using low-profile stents in vessels smaller than 2.0 mm.…”

Stent-assisted coiling using the Neuroform Atlas stent for treatment of aneurysms that recur after coil embolization

“…Two previous studies of SAC using the Atlas stent for treatment of naïve aneurysms have reported thromboembolic complication rates of 3.8 and 2.3%, respectively, and hemorrhagic complication rates of 0.8 and 0.8%, respectively ( 33 , 34 ). Reported thromboembolic complication rates in SAC studies using the Neuroform and Enterprise (Codman Neurovascular, Raynham, MA, USA) stents were 8.8 and 8.7%, respectively ( 35 , 36 ).…”