Object Self-expandable stents have broadened the spectrum of endovascular treatment of intracranial aneurysms. However procedures involving double stenting in Y or X configuration 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 configuration.

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

Results Fifty-six patients harboring 56 aneurysms were treated with double stenting: 53 ‘Y’ configurations, 3 ‘X’ configurations. Deployment was successful in all but one case of Y stenting, which was prematurely interrupted because of aneurysm perforation. 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 peri-procedural complication rate was 14%. The overall morbidity rate was 7.1%. Thirty-seven aneurysms underwent follow-up (66%, mean duration: 16 months): 32 aneurysms (86.4%) were completely occluded, 3 aneurysms (8.1%) had a neck remnant, and 2 aneurysms (5.4%) were incompletely occluded.

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

Disclosures G. Ciccio’: None. T. Robert: None. R. Fahed: None. S. Smajda: None. R. Blanc: None. M. Piotin: None.