Pipeline embolization device versus Atlas stent assisted coiling for intracranial aneurysm treatment: a retrospective, propensity score matched study with a focus on midterm outcomes and hospital costs

Wang, Chao; Dong, Linggen; Liu, Jian; Zhang, Y.; Wang, Kun; Liu, Peng; Yang, Xinjian; Lv, Ming

doi:10.1136/jnis-2023-020173

Cited by 7 publications

(4 citation statements)

References 21 publications

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“…There were no significant differences in the rates of aneurysm occlusion (89.9% vs 86.5%, p=0.486), total complications (5.6% vs 11.2%, p=0.177), or favorable functional outcome (96.6% vs 97.8%, p=1.0) between the Atlas and PED groups. 35 The high occlusion rates in our study and the available literature suggest that SAC with the Atlas device remains an efficacious strategy for ICA aneurysm treatment.…”

Section: Discussionmentioning

confidence: 55%

Anterior circulation location-specific results for stent-assisted coiling – carotid versus distal aneurysms: 1-year outcomes from the Neuroform Atlas Stent Pivotal Trial

Hanel,

Cortez,

Jankowitz

et al. 2023

J NeuroIntervent Surg

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BackgroundThe Neuroform Atlas Stent System is an established treatment modality for unruptured anterior and posterior circulation intracranial aneurysms. Location-specific results are needed to guide treatment decision-making. However, it is unclear whether there are differences in safety and efficacy outcomes between carotid and more distal anterior circulation aneurysms.MethodsThe ATLAS IDE trial was a prospective, multicenter, single-arm, open-label interventional study that evaluated the safety and efficacy of the Neuroform Atlas Stent System. We compared differences in efficacy and safety outcomes of proximal internal carotid artery (ICA) versus distal and bifurcation anterior circulation aneurysms.ResultsOf 182 cases, there were 70 aneurysms in the ICA and 112 in the distal anterior circulation (including ICA terminus/bifurcation). There were no significant differences in the primary efficacy endpoint (85.5% vs 83.9%, p=0.78) and complete aneurysm occlusion rates (88.7% vs 87.9%, p=0.78) between proximal ICA aneurysms and distal aneurysms, respectively. Complications were more often encountered in distal and bifurcation aneurysms, but the overall rate of major safety events was low and comparable between the two groups (1.4% vs 6.3%, p=0.14). Recanalization and retreatment rates were also similar between the groups.ConclusionThe results of this study suggest that the Neuroform Atlas Stent System is a safe and efficacious treatment modality for unruptured anterior circulation intracranial aneurysms, regardless of aneurysm location.Trial registration numberNCT02340585.

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Section: Discussionmentioning

confidence: 55%

Anterior circulation location-specific results for stent-assisted coiling – carotid versus distal aneurysms: 1-year outcomes from the Neuroform Atlas Stent Pivotal Trial

Hanel,

Cortez,

Jankowitz

et al. 2023

J NeuroIntervent Surg

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“…The rate of thromboembolic events associated with the NeuroForm Atlas stent was lower than that associated with the LVIS device (4.9%), Neuroform (6.7%) and Enterprise (5.9%) stents according to a meta-analysis [ 24 , 25 ]. A study comparing the complication rates of Pipeline and Atlas stent implantation for aneurysms showed that the midterm complication rates of the PED and Atlas SAC for the treatment of ICA aneurysms were similar (5.6% vs. 11.2%, P = 0.177) [ 26 ]. However, there are few studies focused on identifying the risk factors of ischaemic stroke and stent thrombosis following Atlas stent implantation.…”

Section: Discussionmentioning

confidence: 99%

“…Lynch et al [ 22 ] reported an incidence of 1.4% for intraprocedural rupture or vessel dissection and 1.0% for periprocedural or early haemorrhage. A study in China reported that the incidence of haemorrhagic complications was 1.4% [ 26 ]. According to a multicentre postmarket analysis, 2 patients (1.6%) experienced haemorrhagic complications, with one experiencing complications during the procedure and the second experiencing complications during the postoperative follow-up period [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Neuroform atlas stent treatment for 533 intracranial aneurysms in a large Chinese cohort: complication risk factor analysis

Chen,

Kang,

Wang

et al. 2024

BMC Neurol

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Background The newest generation of Neuroform Atlas stent™ (Stryker, Fremont, California) represents a recent advance of cerebral laser-cut microstents for the treatment of intracranial wide-necked aneurysms, and postoperative complications have been observed among Western patients. We assessed predictors of complications, morbidity, and unfavourable outcomes in a large cohort of patients with aneurysms that were treated with Neuroform Atlas stents in China. Methods This retrospective study included subjects who were treated with Atlas stents in China from November 2020 to January 2022. Results A total of 522 consecutive patients (mean age, 58.9 ± 9.9 years; female, 65.3% [341/522]) with 533 aneurysms were included in the study. In the early postoperative period, the neurological morbidity rate was 7.3% (38/522), the ischaemic stroke rate was 5.0% (26/522), the aneurysm rupture subarachnoid haemorrhage rate was 2.3% (12/522), and the mRS score deterioration rate was 5.4% (28/522). The mortality rate was 0.8% (4/522) in the postoperative period. The rate of neurological morbidity during the follow-up period was 1.2% (6/486). In the multifactor prediction analysis, cerebral infarction, Hunt–Hess grade (3–5), procedure duration, stent length and coil protrusion into the parent artery were found to be independent predictors of neurologic morbidity. The procedure duration, stent length and coil protrusion into the parent artery were found to be independent predictors of mRS score deterioration. Conclusions The incidence of SCA (stent-assisted coiling)-related complications with the Atlas stent in this study population was comparable to that in Western populations. We identified the procedure duration and stent length as novel independent predictors of SCA-related ischaemic stroke, neurological morbidity, and mRS score deterioration among the Chinese population.

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“…Despite the abundant comparisons of FDs with BS or LCS in the literature [ 37 , 38 , 39 , 42 , 43 , 44 ], to be able to determine the level of flow diversion provided by BS specifically, the inclusion of an LCS (as a reference) arm, a BS arm, and an FD separately in the same cohort is crucial; otherwise, the extent of the flow diversion provided by BS would remain undisclosed. Such a comparison has not been performed previously, but it does have clinical relevance: Stent monotherapy and suboptimal coiling (undercoiling) have been proposed as BS-based endovascular treatment alternatives, despite the lack of clear evidence as to the flow diversion capacity of these stents [ 29 , 45 , 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Appraisal of the Flow Diversion Effect Provided by Braided Intracranial Stents

Çay,

Arat

2024

JCM

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Objective: Comparison of the results of stent-assisted coiling (SAC) with braided stents (BS), flow diverters (FD), and laser-cut stents (LCS) to determine the relative flow-diverting capacity of BS (Leo baby and Accero). Methods: Saccular intracranial aneurysms treated by SAC and FD-assisted coiling were retrospectively evaluated. Aneurysm occlusion, as graded per Raymond–Roy score, was categorized as either recanalization/stable residual filling (Group A; lacking a flow diversion effect) or stable/progressive occlusion (Group B with a “flow diversion effect”). Factors predicting the flow diversion effect were evaluated. Results: Of the 194 aneurysms included, LCS, BS, and FD were used in 70 (36.1%), 86 (44.3%), and 38 (19.6%) aneurysms, respectively. Aneurysms treated by FD were larger, had wider necks, and were located on larger parent arteries (p < 0.01, 0.02, and <0.01, respectively). The mean imaging follow-up duration was 24.5 months. There were 29 (14.9%) aneurysms in Group A and 165 (85.1%) in Group B. Among a spectrum of variables, including sex, age, aneurysm size, neck width, parent artery diameter, follow-up duration, and stent type, the positive predictors for stable/progressive aneurysm occlusion were aneurysm size and placement of an FD or BS (p < 0.01 and p < 0.01, respectively, and were positive predictors over LCS: ORs 6.34 (95% CI: 1.62–24.76) and 3.11 (95% CI: 1.20–8.07), respectively) in multivariate analysis. Conclusions: The placement of BS was a predictor of flow diversion over laser-cut stents. However, the flow diversion effect was approximately half that of FDs, suggesting that BS may only be considered to have some (partial) flow diversion effects.

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Pipeline embolization device versus Atlas stent assisted coiling for intracranial aneurysm treatment: a retrospective, propensity score matched study with a focus on midterm outcomes and hospital costs

Cited by 7 publications

References 21 publications

Anterior circulation location-specific results for stent-assisted coiling – carotid versus distal aneurysms: 1-year outcomes from the Neuroform Atlas Stent Pivotal Trial

Anterior circulation location-specific results for stent-assisted coiling – carotid versus distal aneurysms: 1-year outcomes from the Neuroform Atlas Stent Pivotal Trial

Neuroform atlas stent treatment for 533 intracranial aneurysms in a large Chinese cohort: complication risk factor analysis

Appraisal of the Flow Diversion Effect Provided by Braided Intracranial Stents

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