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Case series
Double stent assisted coiling of intracranial bifurcation aneurysms in Y and X configurations with the Neuroform ATLAS stent: immediate and mid term angiographic and clinical follow-up
  1. Gabriele Ciccio1,
  2. Thomas Robert1,2,
  3. Stanislas Smajda1,
  4. Robert Fahed1,
  5. Jean Philippe Desilles1,
  6. Hocine Redjem1,
  7. Simon Escalard1,
  8. Mikael Mazighi1,
  9. Raphael Blanc1,
  10. Michel Piotin1
  1. 1 Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
  2. 2 Neurosurgery, Ospedale Regionale di Lugano-Civico e Italiano, Lugano, Switzerland
  1. Correspondence to Dr Gabriele Ciccio, Interventional Neuroradiology Fondation Ophtalmologique Adolphe de Rothschild Paris Île-de-France France ; gabrielciccio{at}


Purpose Self-expandable stents have broadened the spectrum of endovascular treatment of intracranial aneurysms. However, procedures involving double stenting in Y/X configurations carry a relatively high risk of procedural complications. The Neuroform ATLAS, the evolution of Neuroform EZ, is a nitinol self-expanding hybrid/open cell stent which can be delivered through a low profile 0.017 inch catheter. We present our experience in the treatment of intracranial aneurysms with this stent in Y and X configurations.

Materials and methods We prospectively maintained a database from consecutive patients who underwent double stent assisted coiling with the Neuroform ATLAS, from July 2015 to February 2019. Clinical and angiographic results were analyzed.

Results 55 patients harboring 55 bifurcation aneurysms were treated with double stenting: 52 ‘Y’ configurations, 3 ‘X’ configurations. Deployment was successful in all cases. Post-treatment control angiography showed complete occlusion in 33 cases (60%), neck remnant in 8 cases (14.5%), and incomplete occlusion in 14 cases (25.4%). The overall symptomatic periprocedural complication rate was 12.7%. 38 aneurysms underwent follow-up (69%, mean duration 16 months): 33 aneurysms (87%) were completely occluded, 3 aneurysms (8%) had a neck remnant, and 2 aneurysms (5%) were incompletely occluded.

Conclusion The Neuroform ATLAS is an effective device for treatment of bifurcation aneurysms, allowing good conformability, a high level of navigability, and easy mesh crossing to perform Y/X stenting procedures. The rate of procedural complications remains non-negligible, and an indication for a double stenting procedure should be carefully discussed in a multidisciplinary meeting.

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  • Contributors GC: study design, data collection, data analysis, figure, tables, and writing. TR and SS: data collection, data analysis, and writing. RF, JPD, HR, SE, MM, and RB: data analysis and writing. MP: study design, data collection, data analysis, and writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The local ethics committee approved the research protocol. According to French regulations,the board waived the need for signed consent for patients included in the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data, analytic methods, and study materials will be made available to any researcher for purposes of reproducing the results or replicating the procedure. Requests to receive these materials should be sent to the corresponding author, who will maintain their availability.

  • Patient consent for publication Not required.