Low rates of recanalization for wide-necked aneurysms treated with stenting after balloon-assisted coiling: combination of techniques delivers stable and improved results during follow-up

González, Aglaé Velasco; Stracke, Paul; Nordmeyer, Henning; Heddier, Markus; Saleme, Suzana; Sauerland, Cristina; Berkemeyer, Shoma; Buerke, Boris; Heindel, Walter; Chapot, René

doi:10.1007/s00234-018-2088-z

Cited by 15 publications

(8 citation statements)

References 30 publications

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“…Stent-assisted coiling (SAC) represents an effective and safe treatment option for complex and broad-based intracranial aneurysms. Even though several innovative endovascular concepts such as extra-or intra-aneurysmal flow diverters or bifurcation stents were established during the last decade, SAC remains one of the most frequently applied techniques for wide-necked aneurysms [1][2][3][4][5]. The first stent intended for the treatment of wide-necked aneurysms approved by the FDA in 2002 was the Neuroform Microdelivery Stent System (Stryker, Kalamazoo, MI, USA) [6].…”

Section: Introductionmentioning

confidence: 99%

Two-center experience with Neuroform Atlas stent-assisted coil occlusion of broad-based intracranial aneurysms

et al. 2021

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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%) recatheterization 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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Section: Introductionmentioning

confidence: 99%

Two-center experience with Neuroform Atlas stent-assisted coil occlusion of broad-based intracranial aneurysms

et al. 2021

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“…Another retrospective study by Velasco González et al ( 4 ) demonstrated low rates of recanalization for wide neck aneurysms treated with stenting after BRT, in 87 aneurysms of 80 patients treated between 2009–2012. This relatively old patient pool had long-term follow-up results.…”

Section: Discussionmentioning

confidence: 96%

“…There have been some literatures advocating BST ( 1 2 3 4 ). Some recent case reports demonstrated the feasibility of BST using a low-profile visualized intraluminal stent (LVIS Jr, Microvention, Tustin, CA, USA) with double lumen balloons in the treatment of middle cerebral artery (MCA) aneurysms ( 5 6 ).…”

Section: Introductionmentioning

confidence: 99%

Single Center Experience of the Balloon-Stent Technique for the Treatment of Unruptured Distal Internal Carotid Artery Aneurysms: Sharing a Simple and Reliable Tip to Use Scepter-Atlas Combination

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et al. 2021

J Korean Soc Radiol

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Purpose The balloon-stent technique (BST) has certain strengths as an assisted technique for the treatment of complex aneurysms. After Atlas release, the BST can be executed without an exchange maneuver of the balloon to the stent-delivery catheter. The purpose of this article is to share our experience with the BST using the Scepter-Atlas combination. Materials and Methods Device inspection led us to a simple method to avoid failure in loading Atlas to the Scepter. From March 2018 to December 2019, 57 unruptured distal internal carotid artery (dICA) aneurysms were treated with coil embolization; among which, 25 aneurysms in 23 patients were treated with BST. Clinical and angiographic data were retrospectively collected and reviewed. Results The technical success rate of the Scepter-Atlas combination increased from 50% to 100% after careful inspection. BST angiographic results were comparable to the stent-assisted coil (SAC) group treated during the immediately post-embolization same period (modified Raymond-Roy classification [MRRC] 1 & 2 84% in BST, 96.3% in SAC) and during short-term follow-up (MRRC 1 & 2 95.8% in BST, 88.4% in SAC). A small number of patients showed periprocedural complications, but none had clinical consequences. Conclusion BST using the Scepter-Atlas combination can provide an effective and safe method for the treatment of dICA aneurysms. Scepters can be used as delivery catheters for Atlas.

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“…This may have resulted from balloon-assisted technique because the technique can enable denser packing of the aneurysm fundus and neck region or help mold the coil mass to improve its interface with the parent vessel. [24,25] Regarding the rate of stroke, this was almost 4%. Several factors may explain our low rate of stroke.…”

Section: Discussionmentioning

confidence: 99%

Stent-assisted coiling of unruptured intracranial aneurysms with wide neck

2020

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Objective: Morbidity and mortality in patients experiencing the rupture of intracranial aneurysm ruptures are high. We conducted a systematic review and meta-analysis to investigate the role of stent-assisted coiling (SAC) for unruptured intracranial aneurysms (UIAs) with wide neck. Materials and Methods: The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled proportions with 95% confidence intervals (CIs) of ten outcomes of interest were calculated. Results: We finally reviewed 13 studies, including 976 patients. The technical success of the method was 98.43% (95% CI: 95.62–99.95). Early outcomes included total periprocedural obliteration with a rate of 50.20% (95% CI: 36.09–64.30) and periprocedural rupture with zero rate. During the follow-up period, ranging from 6 months to 2 years, the total postprocedural obliteration rate was 63.83% (95% CI: 45.80–80.18) and the overall late rupture rate was 0.41% (95% CI: 0.00–2.38). The pooled in-stent stenosis rate was calculated at 1.24% (95% CI: 0.02–3.63). We also estimated a pooled rate of 0.02% (95% CI: 0.00–0.51) and 4.33% (95% CI: 2.03–7.23) for total mortality and overall neurological complications, respectively. A pooled rate of 3.94% (95% CI: 1.48–7.33) was found for stroke. Finally, the recanalization rate was recorded at 7.07% (95% CI: 4.35–10.26). Conclusions: SAC of UIAs with wide neck seems to be a safe and acceptable alternative to surgical clipping. Although early results concerning total periprocedural obliteration may be modest, follow-up outcomes may be indicative of adequate occlusion of treated UIAs.

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Low rates of recanalization for wide-necked aneurysms treated with stenting after balloon-assisted coiling: combination of techniques delivers stable and improved results during follow-up

Abstract: Our results suggest that treatment of wide-necked aneuryms with stent placement after BAC yields low recanalization rates and enhanced angiographic outcomes in long-term follow-up.

Cited by 15 publications

References 30 publications

Two-center experience with Neuroform Atlas stent-assisted coil occlusion of broad-based intracranial aneurysms

Two-center experience with Neuroform Atlas stent-assisted coil occlusion of broad-based intracranial aneurysms

Single Center Experience of the Balloon-Stent Technique for the Treatment of Unruptured Distal Internal Carotid Artery Aneurysms: Sharing a Simple and Reliable Tip to Use Scepter-Atlas Combination

Stent-assisted coiling of unruptured intracranial aneurysms with wide neck

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