Endovascular treatment of wide-necked intracranial aneurysms using the Nautilus Intrasaccular System: initial case series of 41 patients at a single center

Abstract

BackgroundEndovascular treatment of intracranial wide-necked and bifurcation aneurysms (WNBA) is technically challenging. The Nautilus Intrasaccular System is designed to provide a mechanical barrier at the aneurysm neck to support coil embolization. We report the results of a single-center series of patients treated for intracranial aneurysms with the Nautilus.MethodsClinical and radiological data were retrospectively collected for all patients treated with the Nautilus for an unruptured or ruptured intracranial aneurysm at our center between March 2021 and March 2022. Clinical outcomes (modified Rankin Scale (mRS) scores), Raymond–Roy angiographic occlusion, recanalization, and complications were measured immediately post-procedure and at 3–6-month follow-up.ResultsA total of 41 patients of mean age 56.7 years (range 37–83 years) were treated with the Nautilus, with 41 saccular aneurysms (18 (43.9%) unruptured and 23 (56.1%) ruptured). The majority of aneurysms (39/41 (95.1%)) were located in the anterior circulation. We experienced no technical complications. One patient had an asymptomatic post-procedural minor stroke related to the procedure. Immediate Class I occlusion was achieved in 30 (73.1%) patients. The rate of all-cause mortality was 7.3% (3/41). One patient was lost to follow-up. At follow-up, 94.5% (35/37) of patients achieved Class I occlusion and 94.5% (35/37) had an mRS score of 0. There were no procedural-related deaths or permanent morbidities at discharge or follow-up.ConclusionThis study demonstrates good safety and effectiveness using the Nautilus Intrasaccular System to treat both ruptured and unruptured intracranial aneurysms. Larger studies are needed to confirm these findings.

Trends in Dual Antiplatelet Therapy Use for Neurointerventional Procedures for the Management of Intracranial Aneurysms

“…If the mesh components protrude into the parent vessel, this poses a risk for thrombosis and antiplatelet medications are recommended [ 73 ]. A recent systematic review about WEB use in ruptured and unruptured aneurysms by Xie et al found 1/7 articles reported any antiplatelet use [ 75 ]. This review found thromboembolic complications to occur in 7% of the collected cases [ 75 ].…”

“…A recent systematic review about WEB use in ruptured and unruptured aneurysms by Xie et al found 1/7 articles reported any antiplatelet use [ 75 ]. This review found thromboembolic complications to occur in 7% of the collected cases [ 75 ]. The current study found 48 studies with 3583 cases that used an intrasaccular device for the management of intracranial aneurysms.…”

Endovascular treatment of intracranial internal carotid artery bifurcation region aneurysms

“…Giant aneurysms are uncommon and account for 7% of all these lesions ( 19 , 21 , 22 ). ICA bifurcation region aneurysms can be divided into wide-necked (neck width ≥4.0 mm or dome-to-neck ratio <2.0) and narrow-necked (neck width <4 mm, dome-to neck ratio >2) aneurysms ( 23 ). In addition, ICA bifurcation region aneurysms can be spontaneous, traumatic or secondary to radiation ( 24 , 25 ).…”