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

Arslan, Gamze; Maus, Volker; Weber, W.; Berlis, Ansgar; Maurer, Christoph J.; Fischer, Sebastian

doi:10.1007/s00234-020-02602-w

Cited by 8 publications

(12 citation statements)

References 20 publications

(26 reference statements)

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“…Closed-cell stent designs, on the other hand, contain the risk of poor wall apposition and kinking tortious vessel curves. We observed a relatively high rate of complete aneurysm obliteration (RROC I) of 78% in the whole study cohort, which is in line with previous studies investigating SACs ranging from 54–81% with different stent models [ 4 , 5 , 19 , 20 , 21 ]. In our study the rate did not differ between different stent models but was numerically higher in the closed-cell LEO+™ stent group.…”

Section: Discussionsupporting

confidence: 91%

“…The stent includes radiopaque markers at the proximal and distal parts to guarantee visualization under fluoroscopy. For the stent delivery it is mandatory to use the Excelsior SL-10 0.016 microcatheter (Stryker, Fremont, CA, USA), and stents are available in diameters and lengths of 3.0 to 4.5 mm and 15 to 30 mm, respectively [ 5 , 6 , 7 ].…”

Section: Methodsmentioning

confidence: 99%

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Procedural Outcome Following Stent-Assisted Coiling for Wide-Necked Aneurysms Using Three Different Stent Models: A Single-Center Experience

Strittmatter

Meyer

Broocks

et al. 2022

JCM

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Previous case series have described the safety and efficacy of different stent models for stent-assisted aneurysm coiling (SAC), but comparative analyses of procedural results are limited. This study investigates the procedural outcome and safety of three different stent models (Atlas™, LEO+™ (Baby) and Enterprise™) in the setting of elective SAC treated at a tertiary neuro-endovascular center. We retrospectively reviewed all consecutively treated patients that received endovascular SAC for intracranial aneurysms between 1 July 2013 and 31 March 2020, excluding all emergency angiographies for acute subarachnoid hemorrhage. The primary procedural outcome was the occlusion rate evaluated with the Raymond–Roy occlusion classification (RROC) assessed on digital subtraction angiography (DSA) at 6- and 12-month follow-up. Safety assessment included periprocedural adverse events (i.e., symptomatic ischemic complications, symptomatic intracerebral hemorrhage, iatrogenic perforation, dissection, or aneurysm rupture and in-stent thrombosis) and in-house mortality. Uni- and multivariable logistic regression analyses were performed to identify patient baseline and aneurysm characteristics that were associated with complete aneurysm obliteration at follow-up. A total of 156 patients undergoing endovascular treatment via SAC met the inclusion criteria. The median age was 62 years (IQR, 55–71), and 73.7% (115) of patients were female. At first follow-up (6-month) and last available follow-up (12 and 18 months), complete aneurysm occlusion was observed in 78.3% (90) and 76.9% (102) of patients, respectively. There were no differences regarding the occlusion rates stratified by stent model. Multivariable logistic analysis revealed increasing dome/neck ratio (adjusted odds ratio (aOR), 0.26.; 95% CI, 0.11–0.64; p = 0.003), increasing neck size (aOR, 0.70; 95% CI, 0.51–0.96; p = 0.027), and female sex (aOR, 4.37; 95% CI, 1.68–11.36; p = 0.002) as independently associated with treatment success. This study showed comparable rates of complete long-term aneurysm obliteration and safety following SAC for intracranial aneurysm with three different stent-models highlighting the procedural feasibility of this treatment strategy with currently available stent-models. Increased neck size and a higher dome/neck ratio were independent variables associated with less frequent complete aneurysm obliteration.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Procedural Outcome Following Stent-Assisted Coiling for Wide-Necked Aneurysms Using Three Different Stent Models: A Single-Center Experience

Strittmatter

Meyer

Broocks

et al. 2022

JCM

View full text Add to dashboard Cite

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“…We attribute the favorable angiographic outcomes to our use of Atlas stent assistance. These rates compare favorably with other multicenter studies that have evaluated Atlas stent performance in SAC of naïve aneurysms ( 12 , 16 , 27 ). The rate of complete occlusion in these studies ranged from 81.3 to 86.7%.…”

Section: Discussionsupporting

confidence: 70%

“…The effectiveness of the Atlas stent in assisting coil embolization to achieve aneurysm occlusion with low rates of recurrence and morbidity has made it an appealing adjunct when treating intracranial aneurysms ( 12 , 15 , 16 ). As the incidence of aneurysm recurrence has increased in conjunction with increased use of endovascular treatment, so has the use of SAC with the Atlas stent to treat these recurrences.…”

Section: Discussionmentioning

confidence: 99%

Stent-assisted coiling using the Neuroform Atlas stent for treatment of aneurysms that recur after coil embolization

et al. 2022

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ObjectiveTo evaluate the safety and efficacy of stent-assisted coiling (SAC) using the Neuroform Atlas stent for aneurysms that recur after coil embolization.MethodsWe retrospectively reviewed patients who underwent SAC using the Neuroform Atlas stent to treat aneurysms that recurred after coil embolization from November 2020 to November 2021. Patient and aneurysm characteristics, procedural details, complications, and angiographic and clinical follow-up outcomes were recorded and analyzed.ResultsEleven patients with 11 recurrent aneurysms were included for analysis. Atlas stent deployment was successful in all cases. Angiography immediately after the SAC procedure and at last follow-up showed complete occlusion in 10 patients (90.9%) and a residual neck in one (9.1%). Mean angiographic and clinical follow-ups were 9.2 and 10 months, respectively. A single procedure-related complication occurred, mildly blurred vision in the left eye, which recovered completely. No permanent morbidity or mortality occurred.ConclusionSAC using the Atlas stent to treat aneurysms that recur after coil embolization is safe and effective. Large-scale studies with long-term follow-up are warranted to confirm our results.

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“…In these, the ASPI values remained low after intravenous administration of ASA. Intravenous administration of ASA reduced even high baseline values in the ASPI test of Aachen minipigs below human therapeutic limits of 30 U [ 20 ]. With regards to the dynamics of platelet inhibition with ASA, statistically significant differences were found between the baseline (t 0 ) and all following time points (t 1, t 2, t 3, t 4, t 5 ) after treatment.…”

Section: Discussionmentioning

confidence: 99%

Platelet function testing using the Multiplate analyzer after administration of aspirin in Aachen minipigs

et al. 2022

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Knowledge of platelet function in pigs and the effectiveness of antiplatelet therapy is important to ensure proper transferability from animal studies to humans. Our aim was to (1) characterize baseline platelet function of Aachen minipigs using the bedside Multiplate analyzer, (2) compare baseline platelet function with Göttingen minipigs, and (3) characterize platelet inhibition within the first 5 minutes after intravenous administration of acetylsalicylic acid (ASA). We characterized the baseline platelet function and hematological parameters in 9 Aachen minipigs. Historical data of 8 unmedicated Göttingen minipigs were used for comparison of baseline values. Platelet inhibition in Aachen minipigs was tested 1–5 minutes after intravenous administration of 500 mg ASA. Multiplate examinations included the following tests: ASPI test (to assess the effect of ASA), adenosine-diphosphate-test (ADP test) and thrombin receptor activating peptide test (TRAP test). Median values and interquartile range (IQR) of the Multiplate baseline tests in Aachen minipigs were as follows: ASPI: 39 U (IQR = 21–71), ADP: 70 U (IQR = 48–73), and TRAP: 8 U (IQR = 6–9), whereas the values in Göttingen minipigs were as follows: ASPI: 70.5 U (IQR = 60–78), ADP: 51 U (IQR = 45–66), and TRAP: 6.5 U (IQR = 4–8). ASPI values of Göttingen minipigs were significantly higher than those of Aachen minipigs (p = 0.046). Intravenous administration of ASA in Aachen minipigs resulted in significant platelet inhibition after 1 minute, which remained stable over a period of 5 minutes (p≤0.038). Aachen minipigs appeared to have a high variance in arachidonic acid-mediated platelet aggregation. In Aachen minipigs, intravenous ASA administration resulted in immediate platelet inhibition.

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

Cited by 8 publications

References 20 publications

Procedural Outcome Following Stent-Assisted Coiling for Wide-Necked Aneurysms Using Three Different Stent Models: A Single-Center Experience

Procedural Outcome Following Stent-Assisted Coiling for Wide-Necked Aneurysms Using Three Different Stent Models: A Single-Center Experience

Stent-assisted coiling using the Neuroform Atlas stent for treatment of aneurysms that recur after coil embolization

Platelet function testing using the Multiplate analyzer after administration of aspirin in Aachen minipigs

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