Clinical Study
The effect of Neuroform stent-assisted coil embolization of wide-necked intracranial aneurysms and clinical factors on progressive aneurysm occlusion on angiographic follow-up

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Abstract

Stent-assisted coil embolization is an endovascular treatment for wide-necked intracranial aneurysms, but the durability of this treatment is not well known. The aim of this study is to investigate the effect of the Neuroform stent (Boston Scientific/Target, Fremont, CA, USA) in progressive occlusion of wide-necked intracranial aneurysms, and to assess any correlation between clinical factors and angiographic follow-up results. The records of 52 patients treated with a Neuroform stent were retrieved for analysis of population characteristics, initial and follow-up angiographic results, and clinical outcomes. Initial angiographic results showed complete occlusion in 21 (40.4%), neck remnants in 22 (42.3%), and residual aneurysms in nine (17.3%). Angiographic follow-up was available in 45 of 52 (86.5%) patients: complete occlusion was achieved in 32 (71.1%), neck remnants were present in eight (17.8%) and residual aneurysms in five (11.1%). Of 31 patients with immediate incomplete obliteration, progressive complete occlusion was achieved in 16 of 28 (57.1%) patients. Clinical follow-up showed good outcomes according to the modified Rankin Scale score. A univariate analysis showed that there was no effect of the tested clinical variables of patient age (p = 0.823), gender (p = 0.419), aneurysm location (p = 0.394), size (p = 0.625) and rupture status (p = 0.721) on aneurysm occlusion at follow-up. We conclude that the Neuroform stent-assisted neck remodelling technique improves progressive occlusion of wide-necked intracranial aneurysms with good clinical outcomes.

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.

References (21)

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