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Wang C, Dong L, Liu J, Zhang Y, Wang K, Liu P, Yang X, Lv M, Zhang Y. Pipeline embolization device versus Atlas stent assisted coiling for intracranial aneurysm treatment: a retrospective, propensity score matched study with a focus on midterm outcomes and hospital costs. J Neurointerv Surg 2024; 16:379-384. [PMID: 37230749 DOI: 10.1136/jnis-2023-020173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Stent assisted coiling (SAC) and flow diverters (FDs) are common endovascular treatments for wide necked cerebral aneurysms, but studies comparing the new generation Atlas SAC and FDs are scarce. We performed a propensity score matched (PSM) cohort study to compare the Atlas SAC and the pipeline embolization device (PED) for proximal internal carotid artery (ICA) aneurysms. METHODS Consecutive ICA aneurysms treated at our institution with either the Atlas SAC or PED were studied. PSM was used to control for age, sex, smoking, hypertension, and hyperlipidemia, and the rupture status, maximal diameter, and neck size of the aneurysm (aneurysms >15 mm and non-saccular aneurysms were excluded). Midterm outcomes and hospital costs were compared between these two devices. RESULTS A total of 309 patients with 316 ICA aneurysms were included. Following PSM, 178 aneurysms treated with the Atlas SAC and PED were matched (n=89 in each group). Aneurysms treated with the Atlas SAC required a slightly longer procedure time, but had lower hospital costs than those treated with the PED (115.2±24.6 vs 102.4±40.8 min, P=0.012; $27 650.2±$6961.4 vs $34 107.0±$3707.2, P<0.001). Atlas SAC and PED treatments showed equivalent aneurysm occlusion rates (89.9% vs 86.5%, P=0.486), complication rates (5.6% vs 11.2%, P=0.177), and a favorable functional outcome (96.6% vs 97.8%, P=1.0) at follow-up (8.2±3.0 vs 8.4±4.2 months, P=0.652). CONCLUSION In this PSM study, midterm outcomes of the PED and Atlas SAC in the treatment of ICA aneurysms were similar. However, SAC required a longer operation time, and the PED may increase the economic cost of inpatients in Beijing, China.
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Affiliation(s)
- Chao Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linggen Dong
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Gao HL, Shao QJ, Chang KT, Li L, Li TX, Gao B. Use of the Neuroform Atlas stent for wide-necked cerebral aneurysms. Sci Rep 2023; 13:13695. [PMID: 37607977 PMCID: PMC10444864 DOI: 10.1038/s41598-023-40725-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/16/2023] [Indexed: 08/24/2023] Open
Abstract
To investigate the effect and safety of the Neuroform Atlas (NFA) stent in stent-assisted coiling of wide-necked intracranial aneurysms, patients with wide-necked intracranial aneurysms were retrospectively enrolled and treated with the NFA stent-assisted coiling. The modified Rankin scale (mRS) grades and Raymond grades were used to assess the clinical outcomes and aneurysm occlusion degrees, respectively, after embolization and at follow-up. Totally, 122 patients were enrolled with 129 wide-necked aneurysms, and forty-nine (40.2%) patients experienced subarachnoid hemorrhage. A total of 134 NFA stents were deployed in all patients. Immediately after endovascular embolization, the Raymond grade was I in 112 (86.8%), II in 8 (6.2%), and III in 9 (7.0%). Complications occurred in 7 (5.7%) patients, including stent displacement in 2 (1.6%) patients, thrombosis and cerebral infarction in 4 (3.3%), and death in 1 (0.8%). Clinical follow-up was performed in 113 (92.6%) patients 6-30 (mean 21) months after embolization, with the mRS grade 0 in 99 (87.6%) patients, 1 in 7 (6.2%), 2 in 5 (4.4%), and 3 in 2 (1.8%). Good prognosis (mRS ≤ 2) was achieved in 111 (98.2%) patients while poor prognosis (mRS > 2) in two (1.8%). Digital subtraction angiography was conducted in 98 (80.3%) patients with 104 (80.6%) aneurysms 6-30 (mean 21) months after embolization. The Raymond grade was grade I in 94 (90.4%) aneurysms, II in 4 (3.8%), and III in 6 (5.8%). Compared with the Raymond grades immediately after embolization, 93 (89.4%) aneurysms disappeared, 9 (8.7%) remained unchanged in the occlusion status, and 2 (1.9%) were recurrent. In conclusion, the NFA stent may have a high aneurysm occlusion rate and a low complication rate in assisting coiling of wide-necked intracranial aneurysms even though further studies are necessary to prove this.
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Affiliation(s)
- Hui-Li Gao
- Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, Henan, China
| | - Qiu-Ji Shao
- Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, Henan, China
| | - Kai-Tao Chang
- Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, Henan, China
| | - Li Li
- Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, Henan, China
| | - Tian-Xiao Li
- Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, Henan, China.
| | - Bulang Gao
- Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, Henan, China
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Ko HC, Shin HS. Stretched and fractured Neuroform Atlas ® stent during a stent‑assisted coil embolization: A case report. Exp Ther Med 2023; 25:207. [PMID: 37090084 PMCID: PMC10119665 DOI: 10.3892/etm.2023.11906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/24/2023] [Indexed: 04/25/2023] Open
Abstract
The Neuroform Atlas® stent is one of the most recently developed stents for coil embolization, with advancements in a lower-profile delivery system, enhanced trackability, smaller cell size, and increased wall conformability. Because of these advantages, the Neuroform Atlas® stent shows high technical success with few procedure-related complications. However, the present study reported a rare complication of a stretched and partially fractured Neuroform Atlas® stent due to unexpected partial withdrawal of microcatheter during deployment for coil embolization of an intracranial aneurysm. The measured length of the stent was ~30 mm, which was greater than the normal length (21 mm). An additional stent was inserted into the distal part of the deployed stent to stabilize the damaged stent and remodel the aneurysm neck. This complication was considered to potentially result from the combination of several factors, including: Curved vessel; open-cell stent; unexpected microcatheter withdrawal during stent deployment; and hooking of the aneurysm selecting microcatheter with stent strut. Understanding the stent design and careful manipulation while avoiding unexpected withdrawal of the microcatheter could prevent this complication.
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Affiliation(s)
- Hak Cheol Ko
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul 05278, Republic of Korea
| | - Hee Sup Shin
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul 05278, Republic of Korea
- Correspondence to: Dr Hee Sup Shin, Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, 892 Dongnam-ro, Gangdong, Seoul 05278, Republic of Korea
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Yi HJ, Shin DS, Kim BT, Lee DH, Sung JH. Comparison of Neuroform Atlas Stent-Assisted Coiling and Coiling Alone in Ruptured Intracranial Aneurysms: A Propensity Score Matching Analysis. Neurosurgery 2023; 92:607-614. [PMID: 36512832 DOI: 10.1227/neu.0000000000002254] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although Neuroform Atlas stent is commonly used in stent-assisted coiling (SAC) to treat ruptured intracranial aneurysms (RIA), its safety and efficacy remain controversial. OBJECTIVE To assess the safety and efficacy of SAC using Neuroform Atlas for treating RIA compared with coiling alone by performing a propensity score matching analysis. METHODS RIA treated with coiling alone and SAC between January 2017 and May 2021 were retrospectively reviewed. Demographics, periprocedural complication rates, angiographic outcomes, and clinical outcomes of the SAC using Neuroform Atlas group and the coiling-alone group were analyzed with 1:1 propensity score matching. RESULTS A total of 375 aneurysms were enrolled, and 274 (63.1%) aneurysms were treated with coiling alone. In total, 101 (26.9%) aneurysms were treated with SAC, and Neuroform Atlas stent was used in 71 aneurysms. In propensity score matching, the SAC using Neuroform Atlas group showed higher incidence of complete occlusion (69.0% vs 56.3%, P = .029), lower rate of recanalization (11.3% vs 25.4%, P = .011), and lesser need for retreatment (7.0% vs 16.9%, P = .016) compared with the coiling-alone group. However, there were no significant differences in periprocedural complications such as intraprocedural thrombosis or postprocedural cerebral infarct between the 2 groups. CONCLUSION The use of Neuroform Atlas is safe and effective for SAC in RIA with comparable procedure-related complication rates but better angiographic outcome in comparison with coiling alone.
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Affiliation(s)
- Ho Jun Yi
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Dong-Seong Shin
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Bum-Tae Kim
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Dong Hoon Lee
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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5
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Dong L, Chen X, Wang J, Zhang L, Zhao Z, Peng Q, Liu P, Lv M. Neuroform atlas stent-assisted coiling of tiny wide-necked intracranial aneurysms. Front Neurol 2022; 13:1020785. [DOI: 10.3389/fneur.2022.1020785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022] Open
Abstract
ObjectiveTo investigate the safety and efficacy of Neuroform Atlas stent-assisted coiling for the treatment of tiny wide-necked intracranial aneurysms and evaluate risk factors associated with procedure-related complications.MethodsWe retrospectively examined 46 patients with 46 tiny wide-necked aneurysms who were treated using Atlas stent-assisted coiling at our institution from August 2020 to May 2022. Patient and aneurysm characteristics, procedural details, procedure-related complications, and angiographic and clinical outcomes were analyzed.ResultsA total of 10 patients presented with aneurysmal rupture. Atlas stent placement was successful in all patients. Angiography immediately after the procedure showed complete occlusion in 38 patients (82.6%), neck remnant in 7 (15.2%), and partial occlusion in 1 (2.2%). The mean angiographic follow-up was 8.4 months (range, 6–16). At the last follow-up, angiography showed complete occlusion in 41 patients (89.1%) and neck remnant in 5 (10.9%). No aneurysm recurrence or in-stent stenosis occurred. Incidence of procedure-related complications was 10.8% (intraprocedural aneurysm rupture, two cases; acute thrombosis, two cases; and coil migration, one case); only one patient (2.2%) experienced procedural neurological morbidity. The mean clinical follow-up was 9.7 months. A favorable outcome was achieved in 45 patients (97.8%). In univariate logistic regression analysis, aneurysm size (odds ratio, 4.538; P = 0.045) was significantly associated with procedure-related complications. However, multivariate analysis found no independent risk factors.ConclusionAtlas stent-assisted coiling of tiny wide-necked intracranial aneurysms is feasible and effective. Outcomes and occlusion rates are favorable and morbidity is low. The complication rate may be higher in larger tiny aneurysms.
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Dong L, Wang J, Chen X, Zhang L, Zhao Z, Peng Q, Jin Z, Wu J, Lv M, Liu P. Stent-assisted coiling using the Neuroform Atlas stent for treatment of aneurysms that recur after coil embolization. Front Neurol 2022; 13:967942. [PMID: 36237610 PMCID: PMC9552843 DOI: 10.3389/fneur.2022.967942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo evaluate the safety and efficacy of stent-assisted coiling (SAC) using the Neuroform Atlas stent for aneurysms that recur after coil embolization.MethodsWe retrospectively reviewed patients who underwent SAC using the Neuroform Atlas stent to treat aneurysms that recurred after coil embolization from November 2020 to November 2021. Patient and aneurysm characteristics, procedural details, complications, and angiographic and clinical follow-up outcomes were recorded and analyzed.ResultsEleven patients with 11 recurrent aneurysms were included for analysis. Atlas stent deployment was successful in all cases. Angiography immediately after the SAC procedure and at last follow-up showed complete occlusion in 10 patients (90.9%) and a residual neck in one (9.1%). Mean angiographic and clinical follow-ups were 9.2 and 10 months, respectively. A single procedure-related complication occurred, mildly blurred vision in the left eye, which recovered completely. No permanent morbidity or mortality occurred.ConclusionSAC using the Atlas stent to treat aneurysms that recur after coil embolization is safe and effective. Large-scale studies with long-term follow-up are warranted to confirm our results.
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Affiliation(s)
- Linggen Dong
- Department of Neurointervention, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiejun Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiheng Chen
- Department of Neurointervention, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Longhui Zhang
- Department of Neurointervention, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhiqiang Zhao
- Department of Neurointervention, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qichen Peng
- Department of Neurointervention, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zeping Jin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jun Wu
| | - Ming Lv
- Department of Neurointervention, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Ming Lv
| | - Peng Liu
- Department of Neurointervention, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Peng Liu
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Giannitto N, Militi A, Sapienza D, Scurria S, Gualniera P, Mondello C, Spagnolo EV, Terranova A, Portelli M, Cervino G, Fiorillo L, Meto A, Alibrandi A, Asmundo A. Application of Third Molar Maturity Index (I3M) for Assessing Adult Age of 18 Years in a Southern Italian Population Sample. Eur J Dent 2022; 17:200-209. [PMID: 35760359 PMCID: PMC9949984 DOI: 10.1055/s-0042-1744373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Age estimation of living or dead individuals has a strategic importance in medicine, anthropology, and forensic science, in the context of mass disasters and in civil or criminal matters such as adoption or asylum. Teeth play a major role in this context in particular, the third molars are useful for determining whether an individual has reached the legal age of 18 years because they are still in development from the age of 14. MATERIALS AND METHODS In this study, a sample of 307 panoramic radiographs performed on healthy subjects aged between 13 and 23 was analyzed to consider the correlation between the maturity index of the third molar (I3M) and age to verify the reliability of the cutoff 0.08 indicated by Cameriere et al in a sample of Italian subjects living in the Province of Messina (Sicily, South Italy) to discern the adult subjects from the minors. STATISTICAL ANALYSIS The analysis of 307 panoramic radiographs resulted in a sensitivity of 89.2% with a confidence interval of 95%, a specificity of 96.5% with a confidence interval of 95%, and a positive predictive value of 96.7%. RESULTS The method proved itself reliable in estimating adulthood in the population of the Messina- Sicily, but the I3M should not be used as the sole indicator to determine whether a person is younger or older than 18 years because age estimation based on dental methods alone has limitations as the third molars suffer from many variations related to their morphology, their location, and their development. CONCLUSION We recommend a combination of several methods that are available to increase accuracy of age estimation, depending on the different legal requirements in civil or criminal cases.
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Affiliation(s)
- Nino Giannitto
- School of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, Messina, Italy
| | - Angela Militi
- School of Dentistry, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, Messina, Italy
| | - Daniela Sapienza
- School of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, Messina, Italy
| | - Serena Scurria
- School of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, Messina, Italy
| | - Patrizia Gualniera
- School of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, Messina, Italy
| | - Cristina Mondello
- School of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, Messina, Italy
| | - Elvira Ventura Spagnolo
- School of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, Messina, Italy
| | - Antonella Terranova
- School of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, Messina, Italy
| | - Marco Portelli
- School of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, Messina, Italy
| | - Gabriele Cervino
- School of Dentistry, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, Messina, Italy,Gabriele Cervino School of Dentistry, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messinavia Consolare Valeria, 1, 98125 MessinaItaly
| | - Luca Fiorillo
- School of Dentistry, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, Messina, Italy,Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli,” Naples, Italy,Department of Dentistry, University of Aldent, Tirana, Albania,Address for correspondence Luca Fiorillo School of Dentistry, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messinavia Consolare Valeria, 1, 98125 MessinaItaly
| | - Aida Meto
- Endodontic Clinical Section, School of Dentistry, Department of Biomedical and Neuromotor Sciences DIBINEM, University of Bologna, Bologna, Italy
| | - Angela Alibrandi
- Department of Economics, University of Messina, Piazza Pugliatti, Messina, Italy
| | - Alessio Asmundo
- School of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, Messina, Italy
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Hou K, Yu J. Application of the Neuroform Atlas Stent in Intracranial Aneurysms: Current Status. Front Neurol 2022; 13:829143. [PMID: 35401410 PMCID: PMC8990925 DOI: 10.3389/fneur.2022.829143] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
The Neuroform Atlas stent (NAS) is the successor of the Neuroform EZ stent. The NAS is compatible with a low-profile 0.0165-inch microcatheter and is soft enough to pass through small and highly tortuous vessels. The NAS can be used in treating intracranial aneurysms at almost all locations, and its use is becoming increasingly common. However, there has not yet been a complete review of NAS applications. Therefore, we performed this review, which addresses several aspects of the NAS, mainly including its characteristics, clinical trials of its application in treating aneurysms, deployment techniques for the device, the prognosis and complications of its application in treating aneurysms, and antiplatelet requirements associated with its use. Based on the evidence reviewed here, as well as our experience, we found that the NAS is a promising device for treating intracranial aneurysms, especially complex and distal aneurysms. This stent can also be used as a powerful tool to assist in rescuing coil migration, completing dual-stent reconstruction, and coiling aneurysms via a transcirculation approach. The device may require antiplatelet therapy at a lower dose and over a shorter period than other stents. The deployment of the NAS to assist in aneurysm coiling can yield good clinical outcomes and an acceptable rate of complications. Thus, the NAS is a promising device.
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Affiliation(s)
| | - Jinlu Yu
- *Correspondence: Jinlu Yu ; orcid.org/0000-0003-2329-7946
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Ozaki T, Fujinaka T, Kidani T, Nishimoto K, Yamazaki H, Sawada H, Taki K, Kanemura Y, Nakajima S. Coil Embolization of Unruptured Cerebral Aneurysms Using Stents in Small Arteries Less Than 2 mm in Diameter. Neurosurgery 2022; 90:538-546. [PMID: 35179131 DOI: 10.1227/neu.0000000000001876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Data regarding the safety and effectiveness of stent placement in small vessels (<2 mm in diameter) for treating wide-necked cerebral aneurysms are limited. OBJECTIVE To report our experience regarding coil embolization of unruptured cerebral aneurysms using stents (specifically the Neuroform Atlas) in small arteries <2 mm in diameter. METHODS Patients with unruptured cerebral aneurysms treated with stent-assisted coil embolization between March 2017 and March 2021 in our hospital were included. RESULTS Of the 137 cerebral aneurysms included in this study, 49 required stent placement and 48 were treated using the Neuroform Atlas in the small vessels measuring <2 mm in diameter (small vessel group [SVG]). In the SVG, 43 aneurysms (87.8%) demonstrated complete occlusion. Regarding complications, 2 (4.1%) patients had in-stent thrombosis during procedures and 5 (10.2%) experienced symptomatic thromboembolic complications, but only 2 (4.1%) had worsening of the modified Rankin scale ≥1 at 90 days after embolization. Patients with middle cerebral artery aneurysms had a higher risk of thrombotic events (5/18 patients, 27.8%), such as symptomatic thromboembolic complications or intraprocedural in-stent thrombus than those with other aneurysms (1/31 patients, 3.2%), in the SVG (P = .0167). CONCLUSION Stent-assisted coil embolization for unruptured cerebral aneurysms using stents, especially the Neuroform Atlas, in small arteries <2 mm in diameter is effective and feasible, but careful perioperative attention should be given to thrombotic events during the embolization of middle cerebral artery aneurysms.
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Affiliation(s)
- Tomohiko Ozaki
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Tomoki Kidani
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Keisuke Nishimoto
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Hiroki Yamazaki
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Haruna Sawada
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Kowashi Taki
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Yonehiro Kanemura
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.,Department of Biomedical Research and Innovation, Institute for Clinical Research, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Shin Nakajima
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
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10
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Hanaoka Y, Koyama JI, Yamazaki D, Fujii Y, Ogiwara T, Horiuchi T. Transradial quadraxial system for coil embolization of distal anterior cerebral artery aneurysms: A radial-first center case series and literature review. J Neuroradiol 2021; 49:169-172. [PMID: 34634296 DOI: 10.1016/j.neurad.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Endovascular treatment is technically challenging as distal anterior cerebral artery (DACA) aneurysms have distal location, small-caliber parent artery, and small size/wide neck. This study evaluated the feasibility and safety of the transradial approach (TRA) with a radial-specific neurointerventional guiding sheath as the first-line technique for DACA aneurysms. METHODS We retrospectively analyzed an institutional database of consecutive patients with DACA aneurysm who underwent coil embolization using TRA. Ten consecutive patients were included in this study. After the radial-specific 6F Simmons guiding sheath (0.088″ inner diameter) was completely engaged into the target common carotid artery, a quadraxial system (6F Simmons guiding sheath/6F intermediate catheter/3.2F intermediate catheter/single microcatheter) was used for embolization. Then, we assessed for procedural success, angiographic outcomes, and procedure-related or vascular access site complications. RESULTS Embolization procedures were conducted using simple coiling in eight and stent-assisted coiling with the trans-cell approach in two patients. The embolization procedure was successful in all patients (n = 10). Moreover, none presented with catheter kinking, parent artery flow stagnation, or system instability during the procedure. Immediate postprocedural angiography revealed complete obliteration in six and residual neck in four patients. Then, eight patients underwent follow-up angiography at a mean of 7.1 months, and none developed recanalization or required retreatment. The postprocedural course was uneventful, and there were no complications. CONCLUSION The transradial quadraxial system had the ability to achieve sufficient stability and kink resistance in DACA aneurysm embolization. Thus, this method was feasible and safe and had a high success rate.
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Affiliation(s)
- Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Daisuke Yamazaki
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yu Fujii
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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11
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Buonomo O, Mormina E, Caragliano AA, Tessitore A, Pitrone A, Velo M, Cavallaro M, Visalli C, Granata F, Vadalà C, Vinci SL. Safety and effect of Neuroform Atlas stent in the treatment of symptomatic intracranial stenosis: A single-center experience. Heliyon 2021; 7:e08040. [PMID: 34604563 PMCID: PMC8473543 DOI: 10.1016/j.heliyon.2021.e08040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/18/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022] Open
Abstract
Background Vascular intracranial stenosis (IS) is a significant cause of acute ischemic stroke (AIS). This single-center study aims to show that symptomatic IS treatment by using the Neuroform Atlas stent (Stryker neurovascular, Kalamazoo, MI, USA) could be effective in reducing vessel stenosis. Methods Ten patients affected by AIS or TIA, in the vascular territory of high-grade intracranial atherosclerotic lesions (>70% of vessel stenosis), older than 18-year-old, were treated by implanting a Neuroform Atlas stent (diameter of 4.5mm in 80% and 4mm in 20%). 70% of the patients underwent pre-stenting intracranial angioplasty. Results Patients were between 54.8 and 83 years old (mean 68.46y ± 8.44y), 70% males and 30% females. At admission, 50% of all patients had an AIS and 50% a TIA. Restoration of the stenotic lumen was obtained after the endovascular procedure. The percentage mean of vascular stenosis was 83.7% ± 6.09% before treatment (t0), 52.2% ± 10.42% at the end of treatment (t1) and 46.2% ± 8.28% at the follow-up (t2). The IS percentage mean reduction between t0 and t1 was 31.5% ± 7.31%, and between t1 and t2 was 6% ± 5.47%, t0 and t2 of 37.5% ± 7.38%. Percentage reduction of IS was highly significant between time t0 and t1 (p = 0.005), and t0 and t2 (p = 0.005), also with a significant reduction between t1 and t2 (p = 0.012). No patient had experienced an increase of the ischemic area in the vascular territory of the target vessel at 3 months from the initial assessment. 10% of patients experienced a 3-months negative outcome (mRS = 5), 90% experienced a favorable outcome (mRS ≤2). Conclusions Intracranial stenosis endovascular treatment with Neuroform Atlas stent provides encouraging results, with a statistically significant association between the vascular caliber improvement and the endovascular treatment.
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Affiliation(s)
- Orazio Buonomo
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Enricomaria Mormina
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonio Armando Caragliano
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Agostino Tessitore
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonio Pitrone
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Mariano Velo
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Marco Cavallaro
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Carmela Visalli
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Francesca Granata
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Carmela Vadalà
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
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12
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Lefevre PH, Schramm P, Kemmling A, Barreau X, Marnat G, Piotin M, Berlis A, Wanke I, Bonafe A, Houdart E. Multi-centric European post-market follow-up study of the Neuroform Atlas Stent System: primary results. J Neurointerv Surg 2021; 14:694-698. [PMID: 34475253 DOI: 10.1136/neurintsurg-2021-017849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/03/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few prospective series have described the safety and effectiveness of the Neuroform Atlas Stent System. We aimed to investigate the efficacy and safety of the device in patients treated for unruptured aneurysm. METHODS ATLAS EU PMCF is a consecutive, prospective, multicentric study that included patients with unruptured saccular aneurysm of all sizes. Follow-up visits were scheduled at 3-6 months and 12-16 months with digital subtraction angiography (DSA) or MRI imaging follow-up as per the site standard of care. The primary efficacy endpoint was adequate aneurysm occlusion (Raymond Roy occlusion grade I and II) on 12 month angiography. The primary safety endpoint was any major stroke or ipsilateral stroke or neurological death within 12 months. RESULTS Of the 106 patients consented, 105 were treated with at least one Neuroform Atlas stent. There was a failed implantation attempt in 1 patient, 85 patients received lateral stenting, and 19 patients received Y-stenting. Mean aneurysm neck size was 4.2 mm (range 1.9-33 mm). Adequate occlusion was observed in 95.1% immediately after the procedure and in 98.9% of cases at 1 year DSA follow-up. Overall, 1.0% (1/102; 95% CI 0.0% to 5.3%) of patients experienced a primary safety endpoint of major stroke. Three minor strokes resulted in a modified Rankin Scale score of 2. CONCLUSIONS In this multicentric, prospective study, stent-assisted coiling of medium size unruptured aneurysms with the Neuroform Atlas stent resulted in a favorable rate of satisfactory occlusion. In our findings, the use of the Y-stenting technique was associated with increased rates of procedural complications. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02783339.
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Affiliation(s)
- Pierre-Henri Lefevre
- Neuroradiology department, Gui de Chauliac Hospital Montpellier University Hospital, Montpellier, France
| | - Peter Schramm
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - André Kemmling
- Institute of Neuroradiology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Xavier Barreau
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Augsburg, Augsburg, Bayern, Germany
| | - Isabel Wanke
- Neuroradiology Department, Hirslanden Clinic, Zurich, Switzerland
| | - Alain Bonafe
- Neuroradiology department, Gui de Chauliac Hospital Montpellier University Hospital, Montpellier, France
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13
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Hanaoka Y, Koyama JI, Yamazaki D, Ogiwara T, Horiuchi T. The need for further study of microcatheter behavior through the trans-cell approach using a Neuroform Atlas stent. J Neuroradiol 2021; 48:406-407. [PMID: 34363846 DOI: 10.1016/j.neurad.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Daisuke Yamazaki
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
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14
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Zhang L, Chen X, Dong L, Liu P, Jia L, Zhang Y, Lv M. Clinical and Angiographic Outcomes After Stent-Assisted Coiling of Cerebral Aneurysms With Laser-Cut and Braided Stents: A Comparative Analysis of the Literatures. Front Neurol 2021; 12:666481. [PMID: 33995263 PMCID: PMC8116799 DOI: 10.3389/fneur.2021.666481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Stent-assisted coiling (SAC) plays an important role in endovascular treatment of intracranial aneurysms (IAs). This comparative analysis examines the safety and efficacy of SAC in general and compares clinical and angiographic outcomes between laser-cut stents and braided stents. Methods: Relevant English-language studies were identified via a PubMed search for published articles regarding outcomes of SAC using laser-cut stents and braided stents published from 2015 to 2020. Data from 56 studies that met our inclusion criteria were pooled and statistically compared. Results: A total of 4,373 patients harboring with 4,540 IAs were included. Patients were divided into two groups on the basis of stent type: laser-cut stents (2,076 aneurysms in 1991 patients; mean follow-up, 12.99 months) and braided stents (2,464 aneurysms in 2382 patients; mean follow-up, 18.41 months). Overall, the rates of successful stent deployment, thromboembolic events, stent stenosis, periprocedural intracranial hemorrhage, permanent morbidity, mortality, and recanalization were 97.72, 4.72, 2.87, 1.51, 2.14, 1.16, and 6.06%, respectively. Laser-cut stents were associated with a significantly higher rate of successful deployment (p = 0.003) and significantly lower rate of periprocedural intracranial hemorrhage (p = 0.048). Braided stents were associated with a significantly lower rate of permanent morbidity (p = 0.015). Conclusion: SAC of IAs using laser-cut stents or braided stents was effective and safe. Rates of thromboembolic events, stent stenosis, mortality, and recanalization were comparable between the stent types. Braided stents were associated with lower permanent morbidity while laser-cut stents were associated with more favorable rates of successful deployment and periprocedural intracranial hemorrhage.
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Affiliation(s)
- Longhui Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Xiheng Chen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Linggen Dong
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Luqiong Jia
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
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15
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Ikeda H, Kinosada M, Kurosaki Y, Handa A, Chin M, Yamagata S. Factors related to microcatheter passage through the trans-cell approach using a low-profile visualized intraluminal support device: an in-vitro study. J Neuroradiol 2021; 49:87-93. [PMID: 33798631 DOI: 10.1016/j.neurad.2021.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE The trans-cell approach using a low-profile visualized intraluminal support (LVIS) device is sometimes used for aneurysm coil embolization. However, factors related to microcatheter passage remain uninvestigated. We aimed to examine in-vitro factors related to microcatheter passage using the trans-cell approach with an LVIS. METHODS Silicone vessel models (inner diameter, 4 mm) were created with different bend segments and a 4-mm hole assuming an aneurysm neck on the side of the greater curvature. The LVIS Blue (4.5 × 32 mm) was deployed at the bend segment, and passability on the trans-cell surface was evaluated by passing the microcatheter along the micro guidewire. A total of 800 passage experiments were performed using two types of microcatheter, ten types of silicone vessel, four cell widths, five cells with the same LVIS device, and two micro guidewire directions in the aneurysm. RESULTS The Headway Duo microcatheter (35.5%, 142/400) tended to have better passability compared with the Headway 17 microcatheter (29.3%, 117/400) (p = 0.070). As the cell width and angle between the trans-cell surface and microcatheter direction increased, passability significantly increased (p = 0.027 and p < 0.001, respectively). There was no significant difference in passability when the micro guidewire was directed to the proximal side versus the distal side (p = 0.45). CONCLUSIONS A large cell width and an obtuse angle between the trans-cell surface and microcatheter direction facilitated good passability. Although statistically marginal, microcatheters with small ledges and small tips had relatively good passability.
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Affiliation(s)
- Hiroyuki Ikeda
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
| | - Masanori Kinosada
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | | | - Akira Handa
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Sen Yamagata
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
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16
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Jankowitz BT, Jadhav AP, Gross B, Jovin TG, Alhajeri AA, Fraser JF, Hanel RA, Sauvageau E, Aghaebrahim A, Frei D, Bellon R, Loy D, Puri AS, Malek AM, Thomas A, Toth G, Lopes DK, Crowley RW, Arthur AS, Reavey-Cantwell J, Lin E, Siddiqui AH, Alexander MJ, Khaldi A, Colby GP, Caplan JM, Satti SR, Turk AS, Spiotta AM, Klucznik R, Hallam DK, Kung D, Froehler MT, Callison RC, Kan P, Hetts SW, Zaidat OO. Pivotal trial of the Neuroform Atlas stent for treatment of posterior circulation aneurysms: one-year outcomes. J Neurointerv Surg 2021; 14:143-148. [PMID: 33722961 PMCID: PMC8785011 DOI: 10.1136/neurintsurg-2020-017115] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/15/2021] [Accepted: 02/19/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Stent-assisted coiling of wide-necked intracranial aneurysms (IAs) using the Neuroform Atlas Stent System (Atlas) has shown promising results. OBJECTIVE To present the primary efficacy and safety results of the ATLAS Investigational Device Exemption (IDE) trial in a cohort of patients with posterior circulation IAs. METHODS The ATLAS trial is a prospective, multicenter, single-arm, open-label study of unruptured, wide-necked, IAs treated with the Atlas stent and adjunctive coiling. This study reports the results of patients with posterior circulation IAs. The primary efficacy endpoint was complete aneurysm occlusion (Raymond-Roy (RR) class I) on 12-month angiography, in the absence of re-treatment or parent artery stenosis >50%. The primary safety endpoint was any major ipsilateral stroke or neurological death within 12 months. Adjudication of the primary endpoints was performed by an imaging core laboratory and a Clinical Events Committee. RESULTS The ATLAS trial enrolled and treated 116 patients at 25 medical centers with unruptured, wide-necked, posterior circulation IAs (mean age 60.2±10.5 years, 81.0% (94/116) female). Stents were placed in all patients with 100% technical success rate. A total of 95/116 (81.9%) patients had complete angiographic follow-up at 12 months, of whom 81 (85.3%) had complete aneurysm occlusion (RR class I). The primary effectiveness outcome was achieved in 76.7% (95% CI 67.0% to 86.5%) of patients. Overall, major ipsilateral stroke and secondary persistent neurological deficit occurred in 4.3% (5/116) and 1.7% (2/116) of patients, respectively. CONCLUSIONS In the ATLAS IDE posterior circulation cohort, the Neuroform Atlas Stent System with adjunctive coiling demonstrated high rates of technical and safety performance.Trial registration number https://clinicaltrials.gov/ct2/show/NCT02340585.
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Affiliation(s)
- Brian T Jankowitz
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | | | - Bradley Gross
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tudor G Jovin
- Department of Neurology, Cooper University Hospital, Camden, New Jersey, USA
| | - Abdulnasser A Alhajeri
- Department of Diagnostic Radiology, Riverside Radiology and Interventional Associates Inc, Columbus, Ohio, USA
| | - Justin F Fraser
- Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Ricardo A Hanel
- Baptist Health System Jacksonville, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Amin Aghaebrahim
- Neurological Institute, Lyerley Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Donald Frei
- Department of Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA
| | - Richard Bellon
- Department of Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA
| | - David Loy
- Department of Radiology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Adel M Malek
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ajith Thomas
- Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gabor Toth
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Eugene Lin
- Neuroscience Department, Mercy Health St Vincent Medical Center Department of Internal Medicine, Toledo, Ohio, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Michael J Alexander
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ahmad Khaldi
- Department of Neurosurgery, Wellstar Health System, Marietta, Georgia, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Justin M Caplan
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sudhakar R Satti
- Department of Neurointerventional Surgery, CCHS, Newark, Delaware, USA
| | - Aquilla S Turk
- Department of Neuroradiology, Prisma Helath, Greenville, South Carolina, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Richard Klucznik
- Division of Interventional Neuroradiology, Houston Methodist Hospital, Houston, Texas, USA
| | - Danial K Hallam
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - David Kung
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael T Froehler
- Cerebrovascular Program, Vanderbilt University, Nashville, Tennessee, USA
| | - R Charles Callison
- Department of Interventional Neurology, Lawnwood Regional Medical Center and Heart Institute, Fort Pierce, Florida, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Steven W Hetts
- Department of Radiology, UCSF, San Francisco, California, USA
| | - Osama O Zaidat
- Department of Neuroscience, St Vincent Mercy Hospital, Toledo, Ohio, USA
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17
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Daou BJ, Palmateer G, Linzey JR, Thompson BG, Chaudhary N, Gemmete JJ, Pandey AS. Stent-assisted coiling of cerebral aneurysms: Head to head comparison between the Neuroform Atlas and EZ stents. Interv Neuroradiol 2021; 27:353-361. [PMID: 33509014 DOI: 10.1177/1591019921989476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Neuroform Atlas stent is thought to have features allowing for an improved stent delivery system. We aimed to provide a comparison of the Atlas and Neuroform EZ stents in patients treated with stent-assisted coiling. METHODS Seventy-seven aneurysms treated with the Atlas stent and 77 aneurysms with similar characteristics treated with the EZ stent were retrospectively compared. Outcomes included angiographic occlusion per the Raymond-Roy (RR) scale, recanalization, retreatment and procedural complications. RESULTS With the Atlas stent, technical success was 100% and immediate RR1 occlusion was 81.8%. Follow-up RR1 was achieved in 83.7%. The recanalization rate was 7% and the retreatment rate was 4.6%. The complication rate was 6.5% (new neurological deficit in 1.3%). With the EZ stent, technical success was 96%, immediate RR1 occlusion was 67.6% and follow-up RR1 was 67.6%. The recanalization rate was 12.7% and the retreatment rate was 14.1%. The complication rate was 10.4% (new neurological deficit in 2.6%). The rate of immediate RR1 occlusion was significantly higher with the Atlas stent (p = 0.03), and the rate of follow-up RR1 was nonsignificantly higher with the Atlas stent (p = 0.08). The retreatment rate was significantly lower with the Atlas stent (p = 0.009). There were no significant differences in the rates of recanalization (p = 0.5) and complications (p = 0.6). CONCLUSIONS Stent-assisted coiling with the Atlas stent is safe and effective and shows better immediate results as compared to the EZ stent, with improved overall follow-up outcomes.
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Affiliation(s)
- Badih J Daou
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Gregory Palmateer
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Joseph R Linzey
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Neeraj Chaudhary
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Joseph J Gemmete
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
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18
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Arslan G, Maus V, Weber W, Berlis A, Maurer C, Fischer S. Two-center experience with Neuroform Atlas stent-assisted coil occlusion of broad-based intracranial aneurysms. Neuroradiology 2021; 63:1093-1101. [PMID: 33410946 DOI: 10.1007/s00234-020-02602-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Stent-assisted coiling (SAC) represents an established treatment option for broad-based intracranial aneurysms. Here we report our initial and follow-up experience with the Neuroform Atlas Stent, a hybrid open- and closed-cell low-profile stent in the treatment of broad-based aneurysms. METHODS All intracranial aneurysms treated by SAC with the intention to apply the Neuroform Atlas Stent between July 2015 and December 2019 were included. Angiographic and clinical results were analyzed including all follow-up examinations. RESULTS A total of 119 aneurysms (8 acutely ruptured) in 112 patients were included. In 19 cases (16.0%) re-catheterization of the aneurysm was performed in a second procedure after failure to re-cross the stent initially. Of all aneurysms, 83.2% (99/119) were completely occluded following the procedure. In 75.6% of all cases (90/119), a single microcatheter was used for both, implantation of the stent and coil occlusion of the aneurysm. At 3-6 and 12 months follow-up, the complete occlusion rates were 75.2 (79/105) and 81.3% (74/91). The thromboembolic (stent thrombosis) and hemorrhagic complication rate was 1.7 (2/119) and 0.8% (1/119), respectively, resulting in a procedure-related morbidity and mortality rate of 0.9 and 0.9% (1/112 patients). CONCLUSION SAC using the Neuroform Atlas Stent offers a safe and effective option to treat broad-based intracranial aneurysms with a high angiographic and clinical success rate. In the majority of procedures, the application of two mircocatheters is not required. Prospective comparative studies might help to identify the value of SAC using the Neuroform Atlas Stent among the growing treatment options for broad-based aneurysms.
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Affiliation(s)
- Gamze Arslan
- Knappschaftskrankenhaus Bochum - Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, In der Schornau 23-25, 44892, Bochum, Germany
| | - Volker Maus
- Knappschaftskrankenhaus Bochum - Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, In der Schornau 23-25, 44892, Bochum, Germany
| | - Werner Weber
- Knappschaftskrankenhaus Bochum - Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, In der Schornau 23-25, 44892, Bochum, Germany
| | - Ansgar Berlis
- Klinik für Diagnostische Radiologie und Neuroradiologie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Christoph Maurer
- Klinik für Diagnostische Radiologie und Neuroradiologie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Sebastian Fischer
- Knappschaftskrankenhaus Bochum - Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, In der Schornau 23-25, 44892, Bochum, Germany.
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19
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Safety and Efficacy of the Neuroform Atlas Stent for Treatment of Intracranial Aneurysms : A Systematic Review and Meta-Analysis. Clin Neuroradiol 2020; 31:1167-1180. [PMID: 33252708 DOI: 10.1007/s00062-020-00979-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The Neuroform Atlas (Stryker Neurovascular, Fremont, CA, USA) is a low-profile laser cut self-expanding nitinol stent designed to provide coil support and wall apposition during aneurysm embolisation. In this study, we performed a meta-analysis of outcomes after treatment with the Neuroform Atlas stent for the purpose of coil embolisation. METHODS The primary objectives of this meta-analysis were to define the safety (treatment-related complications, neurologic outcomes, mortality rate) and the efficacy (aneurysm occlusion rate) of the treatment of intracranial aneurysms with the Neuroform Atlas stent. A systematic review and meta-analysis was performed by searching PubMed, EMBASE, and the Cochrane CENTRAL Library for all published studies on the treatment of intracranial aneurysms with the Neuroform Atlas device up to 6 April 2020. The review was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 14 studies were analysed (577 patients with 593 intracranial aneurysms). The mean age was 58.2 years and 35.6% were male. Technical success of the procedure was 100%. RROC1/RROC2 (Raymond-Roy occlusion classification (RROC) 1/2) (total occlusion/neck remnant) at a mean follow-up of 8.9 months was achieved in 94.8%. RROC3 was 4.9%. All-cause mortality was 1.8% and permanent residual neurological deficit or disability was 2.7%. Overall complications at follow-up were 6.2%. CONCLUSION Our analysis demonstrated good rates of occlusion at follow-up for aneurysms treated with the Atlas device at follow-up. The safety profile appears similar to other low-profile intracranial stents.
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Omoto K, Takayama K, Okamoto A, Myochin K, Wada T, Nakagawa I, Kurokawa S, Nakase H, Kichikawa K. Initial Experience of Coil Embolization for Unruptured Intracranial Aneurysm Combined with Neuroform Atlas and Undersized Flexible Coils. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:135-141. [PMID: 37502736 PMCID: PMC10370664 DOI: 10.5797/jnet.oa.2020-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/20/2020] [Indexed: 07/29/2023]
Abstract
Objective Intraprocedural rupture (IPR) is a rare complication that can occur during endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs). However, it leads to high morbidity and mortality rates. Others have showed that coil flexibility is a risk factor for IPR. Neuroform Atlas (NA) stents can be deployed with 0.0165-inch microcatheters to enable stent assisted coiling (SAC) with a high likelihood. Undersized flexible coils can be inserted initially during SAC. This study aimed to determine whether SAC using NA and highly flexible coils for UIAs can be conducted without IPR. Methods We retrospectively analyzed nine consecutive patients (mean age, 73.2 years; female, n = 6) who underwent SAC for UIAs combined with NA stents and undersized flexible coils between January 2017 and December 2019. Two aneurysms were located at the internal carotid artery (ICA), and one each was located at the ICA-posterior communicating, anterior communicating, middle cerebral, vertebral, vertebra-posterior inferior cerebral and basilar arteries. The mean size of the aneurysms was 4.6 (range, 3.1-8.6) mm. SAC proceeded using the jailing technique. All coils were selected from among the most flexible coils available. We retrospectively assessed technical success rates, aneurysm occlusion at final digital subtraction angiography (DSA), volume embolization ratios (VERs), rates of IPR and symptomatic stroke within 30 days, angiographic findings of aneurysm occlusion at 3 months post-procedure and late adverse events (frequency of aneurysmal rupture, ipsilateral ischemic stroke, and retreated targeted aneurysms). Results The technical success rate was 100%. Complete occlusion (CO) was immediate in 8 (89%) patients and a neck remnant persisted in 1 (11%). No IPR or symptomatic stroke developed within 30 days. During a mean follow-up period of 11.8 months, CO persisted in 8 (89%) patients. No late adverse events occurred. Conclusion The early clinical and angiographic findings of SAC for UIAs combined with an NA stent and undersized flexible coils were favorable for this series.
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Affiliation(s)
- Koji Omoto
- Departments of Neurosurgery, Ishinkai Yao General Hospital, Yao, Osaka, Japan
| | - Katsutoshi Takayama
- Departments of Radiology and Interventional Radiology, Ishinkai Yao General Hospital, Yao, Osaka, Japan
| | - Ai Okamoto
- Departments of Neurosurgery, Ishinkai Yao General Hospital, Yao, Osaka, Japan
| | - Kaoru Myochin
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Takeshi Wada
- Departments of Radiology and Interventional Radiology, Ishinkai Yao General Hospital, Yao, Osaka, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kurokawa
- Departments of Neurosurgery, Ishinkai Yao General Hospital, Yao, Osaka, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
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Kwon O, Chung J. Outcomes of Stent-Assisted Coiling Using the Neuroform Atlas Stent in Unruptured Wide-Necked Intracranial Aneurysms. J Korean Neurosurg Soc 2020; 64:23-29. [PMID: 32759624 PMCID: PMC7819794 DOI: 10.3340/jkns.2020.0054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/30/2020] [Indexed: 11/27/2022] Open
Abstract
Objective Although stent-assisted coiling (SAC) has been reported to be safe and effective in treating wide-necked aneurysms, the technique has procedure-related complications. Thus, we reported our experiences of SAC using the Neuroform Atlas stent in treating wide-necked aneurysms and evaluated the incidence of and risk factors for procedure-related complications.
Methods From March 2018 to August 2019, we treated 130 unruptured wide-necked aneurysms in 123 patients with Neuroform Atlas stents. Angiographic results and clinical outcomes were reviewed retrospectively. Clinical and angiographic follow-up were performed in all cases (mean, 12.4 months) after the procedure.
Results There were eight cases (6.2%) of procedure-related complications (two dissections, five thromboembolisms, and one hemorrhage) and two (1.5%) of delayed complications (one ischemia and one hemorrhage). There was one case (0.8%) of failure of stent deployment and one (0.8%) of suboptimal positioning of the stent. Follow-up angiography showed complete obliteration in 103 (79.2%), residual neck in 16 (12.3%), and residual aneurysm in 11 cases (8.5%). Aneurysm locations in the middle cerebral artery (odds ratio [OR], 2.211; p=0.046) and the anterior communicating artery (OR, 2.850; p=0.039) were associated with procedure-related complications on univariate analysis. However, no independent risk factor for procedure-related complications was noted in multivariate analysis.
Conclusion The Neuroform Atlas showed a high rate of technical success. Good clinical and radiographic outcomes in early follow-up suggests that the device is feasible and safe. SAC of aneurysms on the middle cerebral artery or anterior communicating artery may require more attention to prevent possible procedure-related complications.
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Affiliation(s)
- Ohyuk Kwon
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joonho Chung
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Zaidat OO, Hanel RA, Sauvageau EA, Aghaebrahim A, Lin E, Jadhav AP, Jovin TG, Khaldi A, Gupta RG, Johnson A, Frei D, Loy D, Malek A, Toth G, Siddiqui A, Reavey-Cantwell J, Thomas A, Hetts SW, Jankowitz BT. Pivotal Trial of the Neuroform Atlas Stent for Treatment of Anterior Circulation Aneurysms: One-Year Outcomes. Stroke 2020; 51:2087-2094. [PMID: 32568654 PMCID: PMC7306258 DOI: 10.1161/strokeaha.119.028418] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stent-assisted coil embolization using the new generation Neuroform Atlas Stent System has shown promising safety and efficacy. The primary study results of the anterior circulation aneurysm cohort of the treatment of wide-neck, saccular, intracranial, aneurysms with the Neuroform Atlas Stent System (ATLAS trial [Safety and Effectiveness of the Treatment of Wide Neck, Saccular Intracranial Aneurysms With the Neuroform Atlas Stent System]) are presented. METHODS ATLAS IDE trial (Investigational Device Exemption) is a prospective, multicenter, single-arm, open-label study of wide-neck (neck ≥4 mm or dome-to-neck ratio <2) intracranial aneurysms in the anterior circulation treated with the Neuroform Atlas Stent and approved coils. The primary efficacy end point was complete aneurysm occlusion (Raymond-Roy class 1) on 12-month angiography, in the absence of retreatment or parent artery stenosis (>50%) at the target location. The primary safety end point was any major stroke or ipsilateral stroke or neurological death within 12 months. Adjudication of the primary end points was performed by an independent Imaging Core Laboratory and the Clinical Events Committee. RESULTS A total of 182 patients with wide-neck anterior circulation aneurysms at 25 US centers were enrolled. The mean age was 60.3±11.4 years, 73.1% (133/182) women, and 80.8% (147/182) white. Mean aneurysm size was 6.1±2.2 mm, mean neck width was 4.1±1.2 mm, and mean dome-to-neck ratio was 1.2±0.3. The most frequent aneurysm locations were the anterior communicating artery (64/182, 35.2%), internal carotid artery ophthalmic artery segment (29/182, 15.9%), and middle cerebral artery bifurcation (27/182, 14.8%). Stents were placed in the anticipated anatomic location in all patients. The study met both primary safety and efficacy end points. The composite primary efficacy end point of complete aneurysm occlusion (Raymond-Roy 1) without parent artery stenosis or aneurysm retreatment was achieved in 84.7% (95% CI, 78.6%-90.9%) of patients. Overall, 4.4% (8/182, 95% CI, 1.9%-8.5%) of patients experienced a primary safety end point of major ipsilateral stroke or neurological death. CONCLUSIONS In the ATLAS IDE anterior circulation aneurysm cohort premarket approval study, the Neuroform Atlas stent with adjunctive coiling met the primary end points and demonstrated high rates of long-term complete aneurysm occlusion at 12 months, with 100% technical success and <5% morbidity. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02340585.
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Affiliation(s)
- Osama O Zaidat
- Neuroscience Department, Bon Secours Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z., E.L.)
| | - Ricardo A Hanel
- Lyerly Neurosurgery, Jacksonville, FL (R.A.H., E.A.S., A.A.)
| | | | | | - Eugene Lin
- Neuroscience Department, Bon Secours Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z., E.L.)
| | - Ashutosh P Jadhav
- The Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J.)
| | - Tudor G Jovin
- Cooper University Hospital Neurological Institute, Camden, NJ (T.G.J.)
| | - Ahmad Khaldi
- WellStar Medical Group, Neurosurgery WellStar Health System, Marietta, GA (A.K., R.G.G.)
| | - Rishi G Gupta
- WellStar Medical Group, Neurosurgery WellStar Health System, Marietta, GA (A.K., R.G.G.)
| | - Andrew Johnson
- Swedish Covenant Hospital Neurosurgery, Chicago, IL (A.J.)
| | - Donald Frei
- Radiology Imaging Associates, Swedish Medical Center, Englewood, CO (D.F.)
| | - David Loy
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville (D.L.)
| | - Adel Malek
- Department of Neurosurgery, Tufts Medical Center, Boston, MA (A.M.)
| | - Gabor Toth
- Cerebrovascular Center, Cleveland Clinic, OH (G.T.)
| | | | | | - Ajith Thomas
- Beth Israel Deaconess Medical Center, Boston, MA (A.T.)
| | - Steven W Hetts
- Interventional Neuroradiology, University of California San Francisco, San Francisco (S.W.H.)
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Burkhardt JK, Srinivasan V, Srivatsan A, Albuquerque F, Ducruet AF, Hendricks B, Gross BA, Jankowitz BT, Thomas AJ, Ogilvy CS, Maragkos GA, Enriquez-Marulanda A, Crowley RW, Levitt MR, Kim LJ, Griessenauer CJ, Schirmer CM, Dalal S, Piper K, Mokin M, Winkler EA, Abla AA, McDougall C, Birnbaum L, Mascitelli J, Litao M, Tanweer O, Riina H, Johnson J, Chen S, Kan P. Multicenter Postmarket Analysis of the Neuroform Atlas Stent for Stent-Assisted Coil Embolization of Intracranial Aneurysms. AJNR Am J Neuroradiol 2020; 41:1037-1042. [PMID: 32467183 DOI: 10.3174/ajnr.a6581] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/29/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Neuroform Atlas is a new microstent to assist coil embolization of intracranial aneurysms that recently gained FDA approval. We present a postmarket multicenter analysis of the Neuroform Atlas stent. MATERIALS AND METHODS On the basis of retrospective chart review from 11 academic centers, we analyzed patients treated with the Neuroform Atlas after FDA exemption from January 2018 to June 2019. Clinical and radiologic parameters included patient demographics, aneurysm characteristics, stent parameters, complications, and outcomes at discharge and last follow-up. RESULTS Overall, 128 aneurysms in 128 patients (median age, 62 years) were treated with 138 stents. Risk factors included smoking (59.4%), multiple aneurysms (27.3%), and family history of aneurysms (16.4%). Most patients were treated electively (93.7%), and 8 (6.3%) underwent treatment within 2 weeks of subarachnoid hemorrhage. Previous aneurysm treatment failure was present in 21% of cases. Wide-neck aneurysms (80.5%), small aneurysm size (<7 mm, 76.6%), and bifurcation aneurysm location (basilar apex, 28.9%; anterior communicating artery, 27.3%; and middle cerebral artery bifurcation, 12.5%) were common. A single stent was used in 92.2% of cases, and a single catheter for both stent placement and coiling was used in 59.4% of cases. Technical complications during stent deployment occurred in 4.7% of cases; symptomatic thromboembolic stroke, in 2.3%; and symptomatic hemorrhage, in 0.8%. Favorable Raymond grades (Raymond-Roy occlusion classification) I and II were achieved in 82.9% at discharge and 89.5% at last follow-up. mRS ≤2 was determined in 96.9% of patients at last follow-up. The immediate Raymond-Roy occlusion classification grade correlated with aneurysm location (P < .0001) and rupture status during treatment (P = .03). CONCLUSIONS This multicenter analysis provides a real-world safety and efficacy profile for the treatment of intracranial aneurysms with the Neuroform Atlas stent.
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Affiliation(s)
- J-K Burkhardt
- From the Department of Neurosurgery (J.-K.B., V.S., A.S., O.T., J.J., S.C., P.K.), Baylor College of Medicine, Houston, Texas
| | - V Srinivasan
- From the Department of Neurosurgery (J.-K.B., V.S., A.S., O.T., J.J., S.C., P.K.), Baylor College of Medicine, Houston, Texas
| | - A Srivatsan
- From the Department of Neurosurgery (J.-K.B., V.S., A.S., O.T., J.J., S.C., P.K.), Baylor College of Medicine, Houston, Texas
| | - F Albuquerque
- Department of Neurosurgery (F.A., A.F.D., B.H.), Barrow Neurological Institute, Phoenix, Arizona
| | - A F Ducruet
- Department of Neurosurgery (F.A., A.F.D., B.H.), Barrow Neurological Institute, Phoenix, Arizona
| | - B Hendricks
- Department of Neurosurgery (F.A., A.F.D., B.H.), Barrow Neurological Institute, Phoenix, Arizona
| | - B A Gross
- Department of Neurological Surgery (B.A.G.), University of Pittsburgh Medical Center Presbyterian, Pittsburgh, Pennsylvania
| | - B T Jankowitz
- Department of Neurosurgery (B.T.J.), Cooper University, Camden, New Jersey
| | - A J Thomas
- Beth Israel Deaconess Medical Center (A.J.T., C.S.O., G.A.M.), Harvard Medical School, Boston, Massachusetts
| | - C S Ogilvy
- Beth Israel Deaconess Medical Center (A.J.T., C.S.O., G.A.M.), Harvard Medical School, Boston, Massachusetts
| | - G A Maragkos
- Beth Israel Deaconess Medical Center (A.J.T., C.S.O., G.A.M.), Harvard Medical School, Boston, Massachusetts
| | | | - R W Crowley
- Department of Neurosurgery (R.W.C.), Rush Medical College, Chicago, Illinois
| | - M R Levitt
- Department of Neurological Surgery (M.R.L., L.J.K.), University of Washington, Seattle, Washington
| | - L J Kim
- Department of Neurological Surgery (M.R.L., L.J.K.), University of Washington, Seattle, Washington
| | - C J Griessenauer
- Department of Neurosurgery (C.J.G., C.M.S., S.D.), Geisinger Health, Danville, Pennsylvania.,Research Institute of Neurointervention (C.J.G., C.M.S.), Paracelsus Medical University, Salzburg, Austria
| | - C M Schirmer
- Department of Neurosurgery (C.J.G., C.M.S., S.D.), Geisinger Health, Danville, Pennsylvania.,Research Institute of Neurointervention (C.J.G., C.M.S.), Paracelsus Medical University, Salzburg, Austria
| | - S Dalal
- Department of Neurosurgery (C.J.G., C.M.S., S.D.), Geisinger Health, Danville, Pennsylvania
| | - K Piper
- Department of Neurosurgery (K.P., M.M.), University of Southern Florida College of Public Health, Tampa, Florida
| | - M Mokin
- Department of Neurosurgery (K.P., M.M.), University of Southern Florida College of Public Health, Tampa, Florida
| | - E A Winkler
- Department of Neurological Surgery (E.A.W., A.A.A.), University of California, San Francisco, San Francisco, California
| | - A A Abla
- Department of Neurological Surgery (E.A.W., A.A.A.), University of California, San Francisco, San Francisco, California
| | - C McDougall
- Department of Neurosurgery (C.M., L.B., J.M.), University of Texas Health San Antonio, San Antonio, Texas
| | - L Birnbaum
- Department of Neurosurgery (C.M., L.B., J.M.), University of Texas Health San Antonio, San Antonio, Texas
| | - J Mascitelli
- Department of Neurosurgery (C.M., L.B., J.M.), University of Texas Health San Antonio, San Antonio, Texas
| | - M Litao
- Department of Neurosurgery (M.L., O.T., H.R.), NYU Langone Medical Center, New York, New York
| | - O Tanweer
- From the Department of Neurosurgery (J.-K.B., V.S., A.S., O.T., J.J., S.C., P.K.), Baylor College of Medicine, Houston, Texas.,Department of Neurosurgery (M.L., O.T., H.R.), NYU Langone Medical Center, New York, New York
| | - H Riina
- Department of Neurosurgery (M.L., O.T., H.R.), NYU Langone Medical Center, New York, New York
| | - J Johnson
- From the Department of Neurosurgery (J.-K.B., V.S., A.S., O.T., J.J., S.C., P.K.), Baylor College of Medicine, Houston, Texas
| | - S Chen
- From the Department of Neurosurgery (J.-K.B., V.S., A.S., O.T., J.J., S.C., P.K.), Baylor College of Medicine, Houston, Texas
| | - P Kan
- From the Department of Neurosurgery (J.-K.B., V.S., A.S., O.T., J.J., S.C., P.K.), Baylor College of Medicine, Houston, Texas
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Pranata R, Yonas E, Deka H, Vania R, July J. Stent-Assisted Coiling of Intracranial Aneurysms Using a Nitinol-Based Stent (Neuroform Atlas): A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 2020; 43:1049-1061. [PMID: 32405704 DOI: 10.1007/s00270-020-02502-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to synthesize the latest evidence on the efficacy and safety of Neuroform Atlas-assisted coiling of intracranial aneurysms. METHODS We performed a comprehensive search for articles that assessed the efficacy and safety of Neuroform Atlas-assisted coiling of intracranial aneurysms. The outcome measurement was adequate occlusion, defined as Raymond-Roy Class I (RR1) + Raymond-Roy Class II (RR2) by previous studies. RESULTS A total of 557 patients (568 aneurysms) from 13 studies were included. The rate of adequate occlusion after the procedure was 88% (83-94%, I2: 72.21%), and the rates of RR1 and RR2 were 68% (60-77%, I2: 81.87%) and 21% (15-27%, I2: 66.10%), respectively. The adequate occlusion rate at 6 months was 90% (81-99%, I2: 58.04%) and 93% (91-96%, I2: 0%) at the end of a mean of 9.03 ± 1.03 months of follow-up. Periprocedural complications occurred in 35 patients [5% (3-8%, I2: 21.28%)]. Subgroup analysis of unruptured aneurysms showed that the rates of adequate occlusion were 85% (78-93%), 90% (79-100%) (6-month follow-up), and 93% (90-96%) (at the end of follow-up). For the wide-necked aneurysm subgroup, the rate of adequate occlusion was 86% (80-93%) and was 93% (89-97%) at the end of follow-up. Meta-regression showed that initial adequate occlusion was influenced by mean aneurysm neck size (p = 0.034). CONCLUSION Neuroform Atlas-assisted coiling is associated with an initial adequate occlusion rate of 88% and a periprocedural complication rate of 6%. The rate of initial adequate occlusion was 85% in unruptured aneurysms and 86% in wide-necked aneurysms. LEVEL OF EVIDENCE Level 2, Systematic review of non-randomized and single-arm studies.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Jl. Jend. Sudirman No. 20, Tangerang, Banten, 15810, Indonesia.
| | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Hadrian Deka
- Faculty of Medicine, Universitas Gadjah Mada, Jogjakarta, Indonesia
| | - Rachel Vania
- Faculty of Medicine, Universitas Pelita Harapan, Jl. Jend. Sudirman No. 20, Tangerang, Banten, 15810, Indonesia
| | - Julius July
- Department of Neurosurgery, Neuroscience Centre Siloam Hospital, Medical Faculty of Pelita Harapan University, Lippo Village, Tangerang, Indonesia
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Park KY, Yeon JY, Kim BM, Jeon P, Kim JH, Jang CK, Kim DJ, Lee JW, Kim YB, Chung J, Song DH, Park HG, Park JS. Efficacy and Safety of Flow-Diverter Therapy for Recurrent Aneurysms after Stent-Assisted Coiling. AJNR Am J Neuroradiol 2020; 41:663-668. [PMID: 32165365 DOI: 10.3174/ajnr.a6476] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Flow-diverter treatment for previously stented aneurysms has been reported to be less effective and prone to complications. In this study, we evaluated the effectiveness and safety of flow diverters for recurrent aneurysms after stent-assisted coiling. MATERIALS AND METHODS Patients who underwent flow-diverter placement for recurrent aneurysms after stent-assisted coiling between March 2015 and March 2019 were recruited. Clinical and radiographic characteristics and clinical and angiographic outcomes were retrospectively evaluated. RESULTS Among 133 patients who underwent flow-diverter insertion, 17 (male/female ratio = 5:12; mean age, 53.8 years) were treated for recurrent aneurysms after stent placement with (n = 16) or without (n = 1) coiling. Eight patients initially presented with subarachnoid hemorrhage; 7, with headache; and 2, with visual field defects. Angiographic morphology included large/giant saccular in 12 patients, dissecting in 2, fusiform in 1, traumatic pseudoaneurysm in 1, and ruptured blood blister-like aneurysm in 1. The duration between the first treatment and flow-diverter placement ranged from 2 weeks to 15 months (median, 6 months). Flow-diverter placement was successful in all cases without any complications. All patients had favorable outcomes (mRS, 0-2), without any newly appearing symptoms. Aneurysms were followed up with conventional angiography at least once in 6-18 months. Sixteen aneurysms showed complete occlusion, and 1 aneurysm was enlarged. CONCLUSIONS Results from this case series investigating flow-diverter placement for recurrent aneurysms after stent-assisted coiling suggested that the procedure is safe and effective. Further study in a larger population may be warranted.
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Affiliation(s)
- K Y Park
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J Y Yeon
- Department of Neurosurgery (J.Y.Y.), Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - B M Kim
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - P Jeon
- Department of Radiology (P.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - J-H Kim
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - C K Jang
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - D J Kim
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J W Lee
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y B Kim
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J Chung
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - D H Song
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - H G Park
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J S Park
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Tomio R, Uesugi T, Akaji K. Stent Migration during Coil Embolization with an Open Cell Stent: A Report of Three Cases. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:188-194. [PMID: 37502694 PMCID: PMC10370679 DOI: 10.5797/jnet.cr.2019-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/20/2020] [Indexed: 07/29/2023]
Abstract
Objective Among 36 cerebral aneurysm cases of stent-assisted coil embolization with the Neuroform Atlas since April 2017, there were three cases of stent migration during the operation. The status of stent deployment, cause of trouble, results of coil embolization, and complications were assessed. Case Presentations There were two cases with trouble during stent deployment, a case of internal carotid artery aneurysm, and a case of middle cerebral artery (MCA) aneurysm. The proximal marker of the stent was advanced during stent deployment with the simple pull maneuver, then a part of the stent migrated to the aneurysm sac in both cases. Stent migration to the aneurysm sac during microcatheter navigation by the trans-cell technique occurred in another MCA aneurysm case. No postoperative complications were observed, and a volume embolization ratio (VER) of 24.1%-33% was achieved in these three cases. Conclusions The Neuroform Atlas is a safe and convenient stent system. However, stent advancement during deployment and migration during trans-cell microcatheter navigation can occur.
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Affiliation(s)
- Ryosuke Tomio
- Department of Neurosurgery and Brain Bank, Mihara Memorial Hospital, Isesaki, Gunma, Japan
| | - Tsuyoshi Uesugi
- Department of Stroke and Brain Bank, Mihara Memorial Hospital, Isesaki, Gunma, Japan
| | - Kazunori Akaji
- Department of Neurosurgery and Brain Bank, Mihara Memorial Hospital, Isesaki, Gunma, Japan
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Goyal RK, Kato Y, Kawase T, Suzuki K, Yamada Y, Sharma S, Balasubramanian SC, Tanaka R, Miyatani K, Daijiro K. Comparative Outcome Analysis of Enterprise and Neuroform Stent-Assisted Coiling of Cerebral Aneurysms: A Review of the Literature. Asian J Neurosurg 2020; 15:4-9. [PMID: 32181165 PMCID: PMC7057877 DOI: 10.4103/ajns.ajns_284_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/11/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction One of the popular treatment strategies for complex cerebral aneurysms with wide necks or low dome-to-neck ratios is stent-assisted coiling. The most widely used intracranial stents for stent-assisted coiling are Neuroform (NF) and Enterprise (EP) stents. The purposes of this study are to review the recent literature of the past 5 years to compare outcomes between the EP and NF stent-assist coiling systems so as to comment on the safety, efficacy, complications, and recurrence rate of stent-assisted coiling in general. Methods PubMed was used to search for all published literature of NF or EP stent-assisted coiling of unruptured cerebral aneurysms from January 2014 to August 2019 with the search terms of "Enterprise stent-assisted coiling," "Neuroform stent," and "Neuroform vs. Enterprise stent." Results Twenty two publications met the inclusion criteria which encompass 1764 patients and 1873 aneurysms. Out of these 1873 aneurysms, 1007 aneurysms were treated with EP stent and 866 aneurysms were treated with NF stent. The overall outcome was low rates of thromboembolic complications (4.37%) and intracranial hemorrhage (1.13%), low permanent morbidity (1.70%) and mortality (0.40%), and lower rate of recanalization (11%). Data analysis shows an overall higher rate of complication and recurrence of aneurysm and lower overall rate of aneurysmal occlusion in the patients where EP stent was used in comparison to NF stent. However, this difference was not statistically significant. Conclusions The review of two stent-assisted coiling devices using EP and NF stents including 1873 aneurysms in 1764 patients revealed that overall, it is safe and effective with comparable outcomes.
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Affiliation(s)
- Ram Kumar Goyal
- Department of Neurosurgery, GNRC Hospital, Guwahati, Assam, India
| | - Yoko Kato
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Tsukasa Kawase
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Kentaro Suzuki
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Yashuhiro Yamada
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Saurabh Sharma
- Department of Neurosurgery, Max Hospital, New Delhi, India
| | | | - Riki Tanaka
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Kyosuke Miyatani
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Kojima Daijiro
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
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