A novel technique for stenting in cases of refractory intracranial stenosis

One-step solution for angioplasty, low-profile stent delivery, and intrastent dilation using a dual-lumen angioplasty balloon microcatheter: technical advances, limitations, outcomes, and literature review

Dual-lumen angioplasty balloon microcatheters make it possible to perform percutaneous transluminal angioplasty (PTA), low-profile stent delivery, and intrastent dilation without the microcatheter exchange technique. This technique has shown many advantages in recent years. We reviewed the techniques and applications in different intracranial vascular diseases and summarized the outcomes and indications. Gateway dual-lumen angioplasty balloon was used for PTA and kept in situ. Stent was delivered and deployed via Gateway microcatheter. Intrastent balloon dilation was performed after stent deployment. We retrospectively reviewed the clinical and imaging data, surgical procedures, technique application, and follow-up outcomes of six patients treated from 2020 to 2023. Neurological function was assessed by the modified Rankin scale (mRS). A literature review was performed using PubMed. All seven patients (4 males, 3 females; mean age, 62.6 ± 6.9 years) underwent percutaneous transluminal angioplasty and stent deployment using a balloon microcatheter. There was one middle cerebral artery (MCA) aneurysm with parent artery stenosis, two MCA dissections, and four intracranial atherosclerotic stenoses (ICASs). The mRS score was 0 in five patients and 1 in two patients. Cerebral dissection with stenosis is the best indication, and its application in stent-assisted aneurysm coiling is inappropriate. This technique is controversial in ICAS treatment.

Use of the Neuroform Atlas stent for wide-necked cerebral aneurysms

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.

A novel technique for stenting of intracranial stenosis using the Neuroform Atlas stent and Gateway balloon catheter

Management of intracranial stenosis remains controversial. Stenting for intracranial stenosis has been associated with high complication and restenosis rates. Morbidity may be related to the intracranial microcatheter exchange that is required in stent placement after the angioplasty. We present a technique in which we deploy an Neuroform Atlas stent through the lumen of a Gateway balloon microcatheter in order to avoid intracranial microcatheter exchange and the associated morbidity. We discuss advantages and pitfalls of this novel technique.