Treatment of a middle cerebral artery bifurcation aneurysm with the novel Contour Neurovascular System compatible with 0.021″ catheters

Abstract

Background For wide-necked intracranial aneurysms, endo-saccular flow disruption can be a viable alternative to coiling or flow diverters. The Contour Neurovascular System is an intrasaccular flow diverter device targeting the neck of the aneurysm. Until now, the system had to be delivered through a 0.027″ microcatheter. We report the first implantation and follow-up of the novel Contour 021 system compatible with 0.021″ microcatheters. Case presentation: A 54-year-old male patient presented with an unruptured right middle cerebral artery aneurysm at the right temporopolar branch. Existing medication included apixaban. An arteriogram showed a broad-based aneurysm. Due to its asymmetric geometry, neither the Woven EndoBridge nor stent-assisted coil embolisation were regarded as promising treatment strategies. To uphold the option of different treatment options, prasugrel 10 mg was initiated before treatment. Implantation was performed under general anaesthesia via femoral artery puncture. A 0.021″ Headway™ catheter was used for accessing the aneurysm. The Contour device was oversized to the equatorial plane. Deployment was successful with only one attempt without the need for re-sheathing. Follow-up catheter angiography was performed after three months, showing complete occlusion of the aneurysm. No procedure-related complications occurred. Conclusion The 0.021 design of the Contour enlarges the subgroup of patients that can be treated with endo-saccular devices and will enable treatment of smaller and more distal aneurysms.

In vitro and in silico assessment of flow modulation after deploying the Contour Neurovascular System in intracranial aneurysm models

“… 30 Coiling carries the advantage of conserving parent vessel flow, but implementation is more complex and not suitable for WNBAs without the use of additional stents or balloons. 10 …”

“…30 Coiling carries the advantage of conserving parent vessel flow, but implementation is more complex and not suitable for WNBAs without the use of additional stents or balloons. 10 In contrast to the NIR, TAWSS, and V reductions, Contour deployment enriches the oscillatory effects inside the aneurysm in some cases (figure 4A and table 1). This finding is in line with a previous study in which OVI increased inside the IA after implanting an FDS.…”

“…Initial studies showed the efficacy and safety of treating unruptured IAs with this device, including WNBAs. [7][8][9][10][11] Moreover, Contour has been used to treat acutely ruptured aneurysms both as a stand-alone device and in combination with coils. [12][13][14][15] A systematic review based on…”

Microsurgical Clipping after Failed Contour Device Embolization of an Anterior Communicating Artery Aneurysm: Technical Note

“…The Contour consists of a nitinol micro-braided memory mesh that adapts itself to the contours of the aneurysm and exerts a combination of flow diversion at the neck and flow disruption and thrombosis within the aneurysm. [3][4][5] Here, we present the feasibility of microsurgical clipping after failed Contour device embolization of an anterior communicating artery aneurysm. We consider knowledge of this treatment option relevant to all practitioners performing Contour embolizations.…”