Clinical StudyThe effect of Neuroform stent-assisted coil embolization of wide-necked intracranial aneurysms and clinical factors on progressive aneurysm occlusion on angiographic follow-up
Introduction
In 1995, the Guglielmi detachable coil system received approval from the United States Food and Drug Administration. Most aneurysms that needed treatment at that time were primarily considered to be amenable to surgery. In subsequent years, the criteria for endovascular treatment have broadened and endovascular treatment is now an established effective treatment in most patients presenting with ruptured or unruptured aneurysms.[1], [2]
The introduction of intracranial stents has significantly contributed to the treatment options for coil occlusion of wide-necked aneurysms. Selective embolization of wide-necked intracranial aneurysms remains difficult because of the risk of coil protrusion within the parent vessel, but stent-assisted coil embolization helps to prevent this.3 In addition, intracranial stents might also reduce the aneurysm recanalization rate. The use of coronary stents as an adjunct to coil embolization was considered initially, but these balloon-mounted stents lacked the necessary flexibility to navigate the tortuosities of the carotid siphon and to reach distal intracranial circulation targets. The pressure-driven method of deployment also increases the risk of damaging the artery and vessel rupture. Wanke et al. reported on the initial clinical experience with a flexible, self-expanding neurovascular stent (Neuroform, Boston Scientific/Target, Fremont, CA, USA), which represented a significant advance in the endovascular treatment of wide-necked aneurysms previously considered not amenable to such therapy.4 Several authors since have documented the feasibility and safety of this device.[5], [6], [7], [8], [9], [10]
The objectives of this study were first to investigate the effect of the Neuroform stent in progressive occlusion of wide-necked intracranial aneurysms, and second, to investigate the impact of clinical factors on angiographic follow-up results of these patients.
Section snippets
Patients
At our institution endovascular treatment is the first therapeutic option for patients with either ruptured or unruptured intracranial aneurysms. After institutional review board approval, we retrospectively analyzed the records of all patients with wide-necked intracranial aneurysms who received treatment or attempted treatment with stent-assisted coil embolization between January 2005 and January 2010. The decision of surgical clipping versus endovascular Neuroform stent-assisted treatment of
Patient population/aneurysm characteristics
We attempted to treat 54 patients with 54 wide-necked aneurysms with this procedure, but stent deployment failed in two patients due to severe tortuosity of the cervical ICA and spasm of the carotid artery and its intracranial branches in the context of acute SAH. These two patients were later treated with surgical clipping; thus, 52 patients (30 women [57.7%] and 22 men [42.3%]) were included in the present analysis. The mean patient age was 51.2 ± 7.5 years. Mean aneurysm size was 10.37 ± 3.76 mm.
Discussion
Our study reveals that the Neuroform stent not only allowed us to treat wide-necked aneurysms safely with an endovascular approach but that it also had excellent delayed aneurysm occlusion. Follow-up clinical outcomes, as measured by the mRS score, continued to be good in this series. In addition, there was no incidence of aneurysmal rupture. There was no significant association between patient age, gender, aneurysm location (anterior versus posterior circulation), aneurysm size or rupture
Conclusion
The present series demonstrates that stent-assisted coiling techniques for treatment of wide-necked intracranial aneurysms are relatively safe and effective. Stent-assisted techniques may not only facilitate the treatment of wide-necked intracranial aneurysms, but more importantly, improve progressive durable occlusion of aneurysms with good clinical outcomes. Patient age, gender, aneurysm location, aneurysm size and rupture status were not predictors of aneurysm occlusion at follow-up.
Conflict of interest/disclosures
The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
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Cited by (19)
A Contemporary Review of Endovascular Treatment of Wide-Neck Large and Giant Aneurysms
2019, World NeurosurgeryCitation Excerpt :Finally, 29 studies were included in this review (Figure 2). Eleven studies in this review included performance data for coiling techniques.6-19 Follow-up duration was predominantly 6 or 12 months, and the technique was stent-assisted coiling in most cases.
Enterprise stent-assisted coiling for wide-necked intracranial aneurysms during ultra-early (48hours) subarachnoid hemorrhage: A single-center experience in 59 consecutive patients
2015, Journal of NeuroradiologyCitation Excerpt :A principal benefit of the Enterprise stent its delivery system, which provides excellent navigability and positioning that make it easy to deliver and deploy. In contrast, earlier studies with the Neuroform stent reported rates of inability to navigate or deploy of 4–14%, and rates of inaccurate deployment of 7.8–8%, compared to an inaccurate deployment rate of 1.3% for the Enterprise stent [11–14]. In our patient series, successful stent navigation and deployment was achieved in 100% of cases, with no instances of stent migration.
Single-centre comparison of procedural complications, clinical outcome, and angiographic follow-up between coiling and stent-assisted coiling for posterior communicating artery aneurysms
2014, Journal of Clinical NeuroscienceCitation Excerpt :In addition, intracranial stents might also reduce the aneurysm recanalisation rate. Several authors have documented the feasibility and safety of these devices [2,4,5]. In this study, we present a series of 291 posterior communicating artery (PcomA) aneurysms that were treated with endovascular coil embolisation; 56 of these aneurysms were treated with a stent.