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

Abstract

Objective : Although stent-assisted coiling (SAC) has been reported to be safe and effective in treating wide-necked aneurysms, the technique has procedure-related complications. Thus, we reported our experiences of SAC using the Neuroform Atlas stent in treating wide-necked aneurysms and evaluated the incidence of and risk factors for procedure-related complications. Methods : From March 2018 to August 2019, we treated 130 unruptured wide-necked aneurysms in 123 patients with Neuroform Atlas stents. Angiographic results and clinical outcomes were reviewed retrospectively. Clinical and angiographic follow-up were performed in all cases (mean, 12.4 months) after the procedure. Results : There were eight cases (6.2%) of procedure-related complications (two dissections, five thromboembolisms, and one hemorrhage) and two (1.5%) of delayed complications (one ischemia and one hemorrhage). There was one case (0.8%) of failure of stent deployment and one (0.8%) of suboptimal positioning of the stent. Follow-up angiography showed complete obliteration in 103 (79.2%), residual neck in 16 (12.3%), and residual aneurysm in 11 cases (8.5%). Aneurysm locations in the middle cerebral artery (odds ratio [OR], 2.211; p=0.046) and the anterior communicating artery (OR, 2.850; p=0.039) were associated with procedurerelated complications on univariate analysis. However, no independent risk factor for procedure-related complications was noted in multivariate analysis. Conclusion : The Neuroform Atlas showed a high rate of technical success. Good clinical and radiographic outcomes in early follow-up suggests that the device is feasible and safe. SAC of aneurysms on the middle cerebral artery or anterior communicating artery may require more attention to prevent possible procedure-related complications.

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

“…This patient's vision recovery supports this hypothesis. 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).…”

Stretched and fractured Neuroform Atlas® stent during a stent‑assisted coil embolization: A case report

“…The procedure-related major adverse events and thromboembolic complications were acceptable, and most of the literature showed very high rates of technical success (Table I) . However, a few cases were reported with suboptimal deployment in unexpected locations and stent migration during the procedure (2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). The suboptimal stent deployment occurred because of the microcatheter's sudden uncontrolled movement to the proximal part of the target artery during the opening and deployment of the stent.…”

“…Because unexpected microcatheter withdrawal occurs more frequently in tortuous vessels, physicians should be aware of this possibility when treating patients with complex vascular architecture using the catheter jailing technique. To avoid unexpected microcatheter movement and incorrect stent deployment, the stent should be deployed with appropriate tension of the push wire, careful unsheathing of the microcatheter, and verified firm landing of the distal stent end (10,11). To prevent the thromboembolic event, we maintain the dual antiplatelet regimen with aspirin (100 mg/day) and clopidogrel (75 mg/day) during the follow-up period.…”

“…Recently published prospective trials showed the efficacy and safety of Neuroform Atlas ® stents in treating IA with an excellent rate of procedure success and acceptable procedure-related complications (2)(3)(4). Among the procedural difficulties, several cases have been reported where stent migration or stent deployment in unexpected landing sites occurred during the procedure (2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Fracture and deformation of intracranial stents have rarely been reported.…”

Y-stent-assisted coiling with Neuroform Atlas stents for wide-necked intracranial bifurcation aneurysms: A preliminary report

“…The deliverability through low-profile microcatheters and its open-cell design are the technical features that allow a safe Y-stenting procedure. A recent case series assessing the outcomes of stent-assisted coiling procedures using Neuroform Atlas stents provided promising results [ 10 , 16 , 17 , 28 ]. However, the number of reports on cases treated with Y-stent-assisted coiling and Neuroform Atlas stents is very limited [ 5 , 9 , 13 , 16 , 28 ].…”