J Korean Neurosurg Soc.  2020 Jan;63(1):80-88. 10.3340/jkns.2019.0154.

Clinical Safety and Effectiveness of Stent-Assisted Coil Embolization with Neuroform Atlas Stent in Intracranial Aneurysm

• Kim CH
• Kim YH
• Sung SK
• Son DW
• Song GS
• Lee SW

• KMID: 2501695
• DOI: http://doi.org/10.3340/jkns.2019.0154

Abstract

Objective
: Stent-assisted coil embolization (SAC) is commonly used for treating wide-neck intracranial aneurysms. In this study, we aimed to assess the clinical safety and efficacy of the NeuroForm Atlas Stent during SAC of intracranial aneurysms.
Methods
: We retrospectively analyzed data from patients with ruptured and unruptured cerebral aneurysms, who underwent SAC using the NeuroForm Atlas between February 2018 and July 2018. Favorable clinical outcomes and degree of aneurysm occlusion were defined as a modified Rankin scale score of ≤2 and a Raymond-Roy occlusion classification (RROC) class I/II during the immediate postoperative period and at the 6-month follow-up, respectively.
Results
: Thirty-one consecutive patients with 33 cases, including 11 ruptured and 22 unruptured cases were treated via NeuroForm Atlas SAC. Among the 22 unruptured cases with 24 unruptured aneurysms had favorable clinical outcome. Complete occlusion (RROC I) was achieved in 16 aneurysms (66.7%), while neck remnants (RROC II) were observed in six aneurysms (25%). Among the 11 patients with ruptured aneurysms, two died due to re-bleeding and diabetic ketoacidosis. In ruptured cases, RROC I was observed in eight (72.7%) and RROC II was observed in three cases (27.3%). At the 6-month follow-up, no clinical events were observed in the 22 unruptured cases. In the ruptured nine cases, five patients recovered without neurologic deficits, while four experienced unfavorable outcomes at 6 months. Of the 29 aneurysms examined via angiography at the 6-month follow-up, 19 (65.5%) were RROC I, eight (27.6%) were RROC II and two (6.9%) were RROC III. There were no procedure-related hemorrhagic complications.
Conclusion
: In this study, we found that stent-assisted coil embolization with NeuroForm Atlas stent may be safe and effective in the treatment of wide-neck intracranial aneurysms. NeuroForm Atlas SAC is feasible for the treatment of both ruptured and unruptured wide-neck aneurysms.

Keyword

Intracranial aneurysm; Stents; Coil

Figure

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  Fig. 1. Case 20. In the roadmap image, the stent was deployed at an inappropriate location. The stent was unable to completely cover the aneurysm neck (A). Due to an inappropriate stent position, the aneurysm was not completely occluded (B).

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  Fig. 2. Case 28. Ruptured anterior communicating artery aneurysm was successfully treated with the double catheter technique (A). However, the detachment zone (black arrow) of the last coil protruded to the parent artery (B), contralateral A2 flow was decreased/blocked due to the thrombus. The detachment zone of the protruding coil was inserted into the aneurysm using the NeuroForm Atlas stent (white arrow) and the flow was restored (C).

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  Fig. 3. Case 30. A patient with a ruptured posterior communicating artery aneurysm (A). A double catheter technique was used to treat the aneurysm and if the coil was protruded, a microcatheter was used to deploy the stent (B). The last coil protruded into the parent artery (C), an unstable migrating coil loop addressed via deployment of the NeuroForm Atlas stent (D).

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  Fig. 4. Case 33. Stent-assisted coil embolization of the ruptured internal carotid artery dorsal wall aneurysm was performed (A). In the follow-up angiogram after 3 weeks, contrast filling of the sac and movement of the protruding unstable coil loop were observed (B). Very severe vessel tortuosity was unavailable for sac selection, and an additional NeuroForm Atlas stent was deployed (C). The aneurysm sac contrast filling was not visible and the coil loop was fixed (D).

Reference

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