Usefulness of the Neuroform Stent for the Treatment of Cerebral Aneurysms: Results at Initial (3–6-mo) Follow-up

Fiorella, David; Albuquerque, Felipe C.; Deshmukh, Vivek R.; McDougall, Cameron G.

doi:10.1227/01.neu.0000159645.86823.af

Cited by 290 publications

(205 citation statements)

References 10 publications

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“…Early promising results with stents provide tantalizing promise of the ability to treat more complex aneurysms. 9 However, the addition of stents, even in very experienced hands, increases the rate of morbidity and mortality. Over the 7 years from January 2002 to January 2009, Piotin et al 23 from Moret's group treated 1325 aneurysms in 1137 patients via endovascular techniques.…”

Section: Evolution Of Treatmentmentioning

confidence: 99%

The Barrow Ruptured Aneurysm Trial: 3-year results

Spetzler

McDougall

Albuquerque

et al. 2013

JNS

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284

176

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Object The authors report the 3-year results of the Barrow Ruptured Aneurysm Trial (BRAT). The objective of this ongoing randomized trial is to compare the safety and efficacy of microsurgical clip occlusion and endovascular coil embolization for the treatment of acutely ruptured cerebral aneurysms and to compare functional outcomes based on clinical and angiographic data. The 1-year results have been previously reported. Methods Two-hundred thirty-eight patients were assigned to clip occlusion and 233 to coil embolization. There were no anatomical exclusions. Crossovers were allowed based on the treating physician's determination, but primary outcome analysis was based on the initial assignment to treatment modality. Patient outcomes were assessed independently using the modified Rankin Scale (mRS). A poor outcome was defined as an mRS score > 2. At 3 years' follow-up 349 patients who had actually undergone treatment were available for evaluation. Of the 170 patients who had been originally assigned to coiling, 64 (38%) crossed over to clipping, whereas 4 (2%) of 179 patients assigned to surgery crossed over to coiling. Results The risk of a poor outcome in patients assigned to clipping compared with those assigned to coiling (35.8% vs 30%) had decreased from that observed at 1 year and was no longer significant (OR 1.30, 95% CI 0.83–2.04, p = 0.25). In addition, the degree of aneurysm obliteration (p = 0.0001), rate of aneurysm recurrence (p = 0.01), and rate of retreatment (p = 0.01) were significantly better in the group treated with clipping compared with the group treated with coiling. When outcomes were analyzed based on aneurysm location (anterior circulation, n = 339; posterior circulation, n = 69), there was no significant difference in the outcomes of anterior circulation aneurysms between the 2 assigned groups across time points (at discharge, 6 months, 1 year, or 3 years after treatment). The outcomes of posterior circulation aneurysms were significantly better in the coil group than in the clip group after the 1st year of follow-up, and this difference persisted after 3 years of follow-up. However, while aneurysms in the anterior circulation were well matched in their anatomical location between the 2 treatment arms, this was not the case in the posterior circulation where, for example, 18 of 21 posterior inferior cerebellar artery aneurysms were in the clip group. Conclusions Based on mRS scores at 3 years, the outcomes of all patients assigned to coil embolization showed a favorable 5.8% absolute difference compared with outcomes of those assigned to clip occlusion, although this difference did not reach statistical significance (p = 0.25). Patients in the clip group had a significantly higher degree of aneurysm obliteration and a significantly lower rate of recurrence and retreatment. In post hoc analysis examining only anterior circulation aneurysms, no outcome difference between the 2 treatment cohorts was observed at any recorded time point. Clinical trial registration no.: NCT01593267 (ClinicalTrials.gov).

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Section: Evolution Of Treatmentmentioning

confidence: 99%

The Barrow Ruptured Aneurysm Trial: 3-year results

Spetzler

McDougall

Albuquerque

et al. 2013

JNS

Self Cite

284

176

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“…Thus, an understanding of the factors that contribute to stent malapposition is of significant impact. 6,20,21 In addition, malapposed stents can mechanically impair re-entry to stented vessels, for subsequent retreatment of the aneurysm or distal vascular access.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] The role of these devices in the treatment and prevention of ischemic and hemorrhagic strokes continues to expand, as has recognition of the importance of assessing the relationship between an implanted device and its host vessel for acute periprocedural success and for long-term biologic response. Such devices are fabricated from metal alloys, typically nickel-titanium (nitinol), platinum, or cobaltchromium, and have strut or filament diameters of Ͻ75 msubstantially smaller than those of stents designed for coronary and carotid applications.…”

mentioning

confidence: 99%

Contrast-Enhanced Angiographic Cone-Beam CT of Cerebrovascular Stents: Experimental Optimization and Clinical Application

Patel¹,

Gounis²,

Wakhloo³

et al. 2010

AJNR Am J Neuroradiol

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“…Undulations of the vessel walls are sometimes obvious on angiograms after oversized deployment of a Neuroform or Solitaire stent. Fibrocellular in-growth within the stented vessel segment promotes increased durability of coil-occlusion and may be more pronounced in an open-cell design stent [26] . In-stent stenosis due to neointimal hyperplasia occurs in about 5 -6 % of patients after Neuroform implantation for aneurysm treatment [27] .…”

Section: Cells Not Connectedmentioning

confidence: 99%