Procedural Outcome Following Stent-Assisted Coiling for Wide-Necked Aneurysms Using Three Different Stent Models: A Single-Center Experience

Abstract

Previous case series have described the safety and efficacy of different stent models for stent-assisted aneurysm coiling (SAC), but comparative analyses of procedural results are limited. This study investigates the procedural outcome and safety of three different stent models (Atlas™, LEO+™ (Baby) and Enterprise™) in the setting of elective SAC treated at a tertiary neuro-endovascular center. We retrospectively reviewed all consecutively treated patients that received endovascular SAC for intracranial aneurysms between 1 July 2013 and 31 March 2020, excluding all emergency angiographies for acute subarachnoid hemorrhage. The primary procedural outcome was the occlusion rate evaluated with the Raymond–Roy occlusion classification (RROC) assessed on digital subtraction angiography (DSA) at 6- and 12-month follow-up. Safety assessment included periprocedural adverse events (i.e., symptomatic ischemic complications, symptomatic intracerebral hemorrhage, iatrogenic perforation, dissection, or aneurysm rupture and in-stent thrombosis) and in-house mortality. Uni- and multivariable logistic regression analyses were performed to identify patient baseline and aneurysm characteristics that were associated with complete aneurysm obliteration at follow-up. A total of 156 patients undergoing endovascular treatment via SAC met the inclusion criteria. The median age was 62 years (IQR, 55–71), and 73.7% (115) of patients were female. At first follow-up (6-month) and last available follow-up (12 and 18 months), complete aneurysm occlusion was observed in 78.3% (90) and 76.9% (102) of patients, respectively. There were no differences regarding the occlusion rates stratified by stent model. Multivariable logistic analysis revealed increasing dome/neck ratio (adjusted odds ratio (aOR), 0.26.; 95% CI, 0.11–0.64; p = 0.003), increasing neck size (aOR, 0.70; 95% CI, 0.51–0.96; p = 0.027), and female sex (aOR, 4.37; 95% CI, 1.68–11.36; p = 0.002) as independently associated with treatment success. This study showed comparable rates of complete long-term aneurysm obliteration and safety following SAC for intracranial aneurysm with three different stent-models highlighting the procedural feasibility of this treatment strategy with currently available stent-models. Increased neck size and a higher dome/neck ratio were independent variables associated with less frequent complete aneurysm obliteration.

Procedural outcome following and Hemodynamic imaging analysis for anterior communicating artery wide-necked aneurysms by four different stents assisted coil embolization

“…This paper is the first to study four types of stents (Solitaire ™ , Enterprise ™ , LVIS(JR) ™ , LEO+(Baby) ™ ) simultaneously. Previous studies on the effects of Atlas ™ , Enterprise ™ , and LEO ™ stents on angiographic outcomes after SAC of wide-neck aneurysms showed a high incidence of total occlusion at long-term follow-up [29]. No significant difference was similarly observed among different stents, and the results of this research coincided with this finding.…”

Endovascular Treatment of Wide-Neck Bifurcation Aneurysm: Recent Trends in Coil Embolization with Adjunctive Technique

“…Several recent reports evaluating angiographic outcomes and safety in unruptured cases treated with SAC showed no difference when stratified by stent model. 10 , 11) …”

“…Several recent reports evaluating angiographic outcomes and safety in unruptured cases treated with SAC showednodifferencewhenstratifiedbystentmodel. 10,11) In a report on unruptured middle cerebral artery aneurysms,SACsignificantlyreducedtherecurrenceratecompared to simple coiling without increasing the risk of complications. 12) Although SAC has clearly improved the treatment of wide-neck aneurysms, it is not indicated for casesofacuteruptureanditsuseisoff-label.Adecadeago, a review reported a higher complication rate after acute SAC thanwithoutstenting.Recently,itwas reportedthat Neuroform Atlas may be suitable for acutely ruptured aneurysms owing to its low-profile design and reduced metal construction.…”

Sub-satisfactory recanalization of severe middle cerebral artery stenoses can significantly improve hemodynamics

“…The Enterprise stent (Codman, Raynham, MA) was the second one to receive US FDA approval for stent-assisted coiling and the first one with a closed-cell design. It has now become a well-established tool for treatment of aneurysm and intracranial atherosclerotic stenosis as an off-label application ( 9 – 16 ). The second-generation Enterprise stent is a further development with a changed closed-cell design of the strut geometry to improve its adherence to the vascular wall, especially in curved arteries ( 10 ).…”