Low-Profile Laser-Cut Stents for Endovascular Treatment of Intracranial Aneurysms

Goertz, Lukas; Smyk, Michael Artur; Siebert, Eberhard; Turowski, Bernd; Borggrefe, Jan; Mpotsaris, Anastasios; Böhner, Georg; Schlamann, Marc; Dorn, Franziska; Liebig, Thomas; Kabbasch, Christoph

doi:10.1007/s00062-019-00874-1

Cited by 8 publications

(4 citation statements)

References 36 publications

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“…We observed a complication rate of 12.6%. This appears to be comparable to the techniques of balloon remodeling and permanent stent-assisted coiling, for which also complication rates between 10% and 20% have been reported [20][21][22]. However, we would like to draw attention to the fact that it was our intention to record all kinds of unintended events during the procedure as complications, even when they were not associated with the procedure of temporary stenting (e.g., stretching of coils).…”

Section: Discussionsupporting

confidence: 70%

Results of Temporary Stent-assisted Coil Embolization (CATS) for the Treatment of Wide-neck Aneurysms

et al. 2022

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Purpose In intracranial wide-neck aneurysms, simple coil embolization is often not a feasible treatment option. Balloon-assisted coiling comes with the drawback of blood flow impairment, whereas permanent stent placement requires long-term antiplatelet therapy. Temporary stent-assisted coiling (coiling assisted by temporary stenting, CATS) is an alternative that eliminates both disadvantages. Because prior studies included only small numbers of patients, it was our aim to analyze the safety and effectiveness of this technique in a larger cohort of patients. Methods We retrospectively evaluated all endovascular aneurysm treatments at our institution from 2011 to 2020. Out of a total of 688 aneurysm treatments, we intended to perform 95 (14%) with temporary stent-assisted coiling and included them in our study. Results Sixty-four (64)% of aneurysms were acutely ruptured, 3% were symptomatic but unruptured, and 33% were incidental. Successful stent recovery was possible in 93% of treatments. Initial complete and adequate occlusion rate were 53% and 82%, respectively. Long-term follow-up at 6 and 12 months was available for 71% and 44% of cases. Aneurysm recurrence was observed in 10% of cases after 6 months, and in 17% after 1 year or later. Periprocedural complications were noted in 12 cases (13%), of which only 1 complication was definitely associated with temporary stent-assisted coiling (1%). One of the periprocedural complications resulted in neurological damage, the other complications were asymptomatic. Conclusion Temporary stent-assisted coiling appears to be a safe and effective treatment method in intracranial wide-neck aneurysms. Procedural safety appears to be comparable with balloon remodeling or permanent stent-assisted coiling, but it comes with the further benefit of diminished need for posttreatment antiplatelet therapy, which may improve the outcome of patients. However, to define the true value and potential benefit of this technique, further prospective studies are required.

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Section: Discussionsupporting

confidence: 70%

Results of Temporary Stent-assisted Coil Embolization (CATS) for the Treatment of Wide-neck Aneurysms

et al. 2022

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“…The recently published study on 131 procedures with this device showed results and complication rates comparable with those in our study. 17 Another advantage of the small size of the Atlas stent is that it can be deployed by the same coiling catheter, thus simplifying the coiling procedure. Because this is a new device, we still observed a high rate of using 2 separate microcatheters, one for deploying the stent and one jailed in the aneurysm to coil after stent deployment (40.6%).…”

Section: Discussionmentioning

confidence: 99%

Multicenter Postmarket Analysis of the Neuroform Atlas Stent for Stent-Assisted Coil Embolization of Intracranial Aneurysms

Burkhardt

Srinivasan

Srivatsan

et al. 2020

AJNR Am J Neuroradiol

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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 ¼ .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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“…Moreover, SAC allows a higher coil packing density, which usually translates into lower recurrence rates. Limitations of stent-implantation include higher complication rates, in particular thromboembolic events and a necessity of long-term anti-platelet therapy 9 , 22 , 23 .…”

Section: Methodsmentioning

confidence: 99%

Comparison of angiographic outcomes and complication rates of WEB embolization and coiling for treatment of unruptured basilar tip aneurysms

Celik

Özpeynirci

Liebig

et al. 2022

Sci Rep

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Endovascular coiling represents the standard treatment for basilar tip aneurysms. Some of these aneurysms are not amenable to conventional coiling due to a complex aneurysm geometry, hence, novel devices such as the Woven Endobridge (WEB) have been developed. We retrospectively compared WEB embolization and coiling for the treatment of unruptured basilar tip aneurysms. Patients treated with WEB or coiling at four centers were reviewed. Procedure-related complications, clinical outcome and angiographic results were retrospectively evaluated and compared. Forty patients treated with the WEB and 35 patients treated by coiling were included. Stent-assistance was more often necessary for coiling than for WEB embolization (71% vs 2.5%, p < 0.001). The technical success rates were 100% for both methods. The overall complication rates were not significantly different between groups (WEB: 5%, coil: 11%, p = 0.409). Procedural morbidity rates were 9% in the coiling group and 2.5% in the WEB group (p = 0.334). There was no mortality. Treatment duration was shorter for WEB implantation than for coiling (p = 0.048). At mid-term follow-up, complete occlusion, neck remnants and aneurysm remnants were observed in 89%, 4% and 7% for the WEB, respectively, and in 100%, 0% and 0% for coiling. While complication rates and mid-term angiographic outcome was comparable between the groups, the WEB was associated with a shorter treatment duration and required stent-assistance less frequently. The choice of the treatment modality should be made based on the specific aneurysm characteristics, the individual experience of the neurointerventionalist and patient preference.

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Low-Profile Laser-Cut Stents for Endovascular Treatment of Intracranial Aneurysms

Cited by 8 publications

References 36 publications

Results of Temporary Stent-assisted Coil Embolization (CATS) for the Treatment of Wide-neck Aneurysms

Results of Temporary Stent-assisted Coil Embolization (CATS) for the Treatment of Wide-neck Aneurysms

Multicenter Postmarket Analysis of the Neuroform Atlas Stent for Stent-Assisted Coil Embolization of Intracranial Aneurysms

Comparison of angiographic outcomes and complication rates of WEB embolization and coiling for treatment of unruptured basilar tip aneurysms

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