Clinical application of Neuroform Atlas stent-assisted coiling in the treatment of unruptured wide-neck intracranial aneurysms / 北京大学学报(医学版)

OBJECTIVE@#To assess the safety and efficacy of Neuroform Atlas stent used in treatment of unruptured wide-neck intracranial aneurysms.@*METHODS@#Clinical data of 62 patients with unruptured wide-neck intracranial aneurysms undergoing Neuroform Atlas stent-assisted coiling from August 2020 to September 2021 were retrospectively analyzed. There were 64 aneurysms in those 62 patients. Among them, 25 aneurysms were located at the bifurcation of M1 segment on middle cerebral artery, 16 at the anterior communicating artery, 10 at the C7 segment of internal carotid artery, 5 at the C6 segment of internal carotid artery, 4 at the apex of basilar artery, 3 at the A3 segment of anterior cerebral artery, and 1 at the M2 segment of middle cerebral artery. All the patients underwent Neuroform Atlas stent-assisted coiling, including 49 patients with single stent assisted coiling and 15 patients with dual stents assisted coiling (14"Y"style and 1"X"style). After the procedure, the immediate DSA was performed to evaluate the status of aneurysm occlusion and the parent artery patency. The clinical follow-up was performed 3 months after the operation and evaluated based on the modified Rankin Scale(mRS).DSA image was reviewed at 6 months after operation and Raymond grading scale was used to assess the status of aneurysm occlusion and the parent artery patency.@*RESULTS@#A total of 62 patients with 64 aneurysms were all achieved technical success(100%).The immediate post-procedural Raymond scale was assessed, including Raymond Ⅰ in 57 aneurysms(89.1%, 57/64), Raymond Ⅱ in 6 aneurysms(9.3%, 6/64) and Raymond Ⅲ in 1 aneurysm(1.6%, 1/64). The peri-procedural complications rate was 4.8%(3/62), 2 patients developed intraoperative thrombosis and 1 patient suffered from local subarachnoid hemorrhage. Among them, 55 patients obtained 3 months clinical follow-up after operation and all the patients had good outcomes (mRS≤2), 50 patients with 52 aneurysms were followed up with DSA 6 months after operation, including Raymond Ⅰ in 45 aneurysms(86.5%, 45/52), Raymond Ⅱ in 4 aneurysms(7.7%, 4/52) and Raymond Ⅲ in 3 aneurysms(5.8%, 3/52).@*CONCLUSION@#Neuroform Atlas stent for the treatment of unruptured wide-neck intracranial aneurysms has high safety and good efficacy, and has its advantages over other traditional stents.

Solitaire AB Stent-Assisted Coiling of Wide-Neck Micro Aneurysms

OBJECTIVE: Solitaire AB stent-assisted coiling facilitates the endovascular treatment of wide-necked intracranial aneurysms. We present our experience of coiling the micro-aneurysms of wide-neck with Solitaire AB stent assisting in a single center. METHODS: Thirty-one Solitaire AB stents were used to treat via endovascular approach patients with 31 wide-neck micro aneurysms in a single center in China. Technical and clinical complications were recorded. Modified Rankin Scale was used to evaluate the patients' conditions via clinic and telephone follow-up. RESULTS: The mean width of aneurysm sac was 2.30±0.42 mm, and the mean diameter of aneurysm neck was 2.83±0.48 mm. Complete occlusion was achieved in 28 aneurysms (90.32%); neck remnant was seen in 3 aneurysms (9.68%). Technical and clinical complications related to the procedure were encountered in four patients (12.5%). Two patients died (6.25%). No patient had a permanent deficit. CONCLUSION: Solitaire AB stent was a safe and efficiency tool in assisting coiling of micro aneurysms with wide neck, but may be not suitable for a blaster-like one. Mid- and long-term follow-up will be required to elucidate the impact of the Solitaire AB stent on recanalization rate.

Clinical study of interventional embolization for the treatment of tiny intracranial aneurysms / 介入放射学杂志

Objective To explore the therapeutic efficacy of endovascular embolization for the treatment of tiny intracranial aneurysms (≤3.0 mm) and to discuss its technical skill. Methods During the period from Dec. 2010 to July 2013, a total of 12 patients with tiny intracranial aneurysms (≤3.0 mm) were admitted to authors’ hospital to receive endovascular embolization therapy. Of the 12 patients, narrow-necked aneurysm (neck-to-body ratio ≤0.5) was seen in 7 and embolization with coils only was carried out, while wide-necked aneurysm (neck-to-body ratio > 0.5) was seen in 5 and stent-assisted coils embolization was adopted. Based on Raymond grading standard, the immediate therapeutic results were evaluated, and the procedure-related complications were recorded. Thirty days after the treatment , GOS grade was used to assess the results. Follow-up evaluation with angiography or through call was conducted. Results Successful embolization of the aneurysm was obtained in all the 12 aneurysms , with a success rate of 100%. Angiography performed immediately after the treatment showed that complete embolization was achieved in 8 aneurysms (66.7%) and residual aneurysm cavity was seen in 4 aneurysms (33.3%). GOS grading indicated that 12 cases belonged to grade V. The 12 patients were followed up for 1 - 12 months through telephone , and no re-bleeding occurred. Conclusion For the treatment of tiny intracranial aneurysms (≤ 3.0 mm), endovascular embolization is feasible although its safety and efficacy need to be further observed.

Planned Stage Endovascular Treatment for Complex Wide Neck Aneurysm

Treatment of a complex, wide neck aneurysm sometimes cannot be achieved in a single endovascular session. This case illustrates a planned stage endovascular treatment of a complex aneurysm with remodeling technique aiming to eliminate risk of rebleeding during acute phase in the first stage of treatment, and complete occlusion in the second stage of treatment. After first stage, separation between coil mass and neck remnant was clearly shown indicating presence of neointimal layer. Multiple sessions also provide proper planning and more controlled treatment of difficult aneurysms.

Temporary Semi-Jailing Technique Avoiding Inevitable Antiplatelet Medication for Coil Embolization of Wide-necked Cerebral Aneurysms / 신경중재치료의학

PURPOSE: Stent-assisted neck remodeling for wide-necked aneurysms requires long-term medication with antiplatelet agents. We describe here a temporary semi-jailing technique (SJT) for wide-necked aneurysms that avoids the need for antiplatelet medications. MATERIALS AND METHODS: Among 101 patients who underwent stent- and/or balloon-assisted embolizations, 3 wide-necked aneurysms, including 1 ruptured aneurysm, underwent the temporary SJT using Enterprise stents. Temporary SJTs were used due to resistance to antiplatelet agents prior to cardiac surgery or to a ruptured aneurysm with a wide neck. The aneurysms were located in the middle cerebral artery, the paraclinoid internal carotid artery segment, and the posterior communicating artery. RESULTS: Enterprise stents were retrieved after coiling without any change in coil mass stability. The final angiogram showed good patency of each parent artery, good stability of the coil mass and total occlusion of the aneurysm. None of the patients experienced any periprocedural or delayed neurological complications. While retrieving the stent from tortuous vessels, we experienced the jumping phenomenon associated with this device. CONCLUSION: Temporary SJTs have the advantage of stent retrieval, thus avoiding inevitable antiplatelet medication. However, care should be taken in tortuous vessels to avoid the jumping phenomenon associated with the device.

A novel intracranial Enterprise stent together with coils for the treatment of very small intracranial wide-necked aneurysms / 介入放射学杂志

Objective To make a preliminary investigation and summary of the technique and efficacy of the novel intracranial stent, Enterprise, together with hydro-detachable coils for the treatment of very small intracranial wide-necked aneurysms (diameter<3 nun and body-to-neck ratio<1.5). Methods Six cases with very small intracranial wide-necked aneurysms were treated with Enterprise stents and hydro-detachable coils. In 5 cases the Enterprise stent was implanted to cover the neck of the aneurysm, which was followed by the introduction of a microcatheter into the aneurysmal sac through the stent mesh to stuff hydro-detachable coils in order to fill the aneurysmal sac. In the remaining case, the microcatheter was placed into the aneurysmal sac before the Enterprise stent was inserted to embolize the aneurysm. Postoperative follow-up was conducted for 3-6 months. Results The operation was successfully completed in all 6 patients, with the implanted stents being in right place. The parent arteries remained patency in all patients. No complications occurred. Complete occlusion of aneurysmal cavity was obtained in four cases, and the occlusion degree of the aneurysmal cavity above 95% was seen in 2 cases. After the procedure, all the patients recovered well. Neither rebleeding nor symptoms related to thrombosis occurred during a clinic follow-up of 3-6 months. Conclusion Endovasculur embolization with Enterprise stent together with hydro-detachable coils is a safe and effective method for the treatment of very small intracranial wide-necked aneurysms. However, its long-term effect needs to be further observed.

Staged Y-shaped Stent Assisted Coil Embolization in a Wide-Neck Basilar Tip Aneurysm: Case Report / 신경중재치료의학

A 67-year-old male presented with a subarachnoid hemorrhage and was found to have a basilar artery (BA) tip aneurysm, which was incorporated to both posterior cerebral arteries (PCAs). First, he was treated with the single stent, which was deployed from P1 segment of the right PCA to BA, and coil embolization was done. Follow-up angiogram at 18 months revealed coil compaction of the aneurysm. Therefore, we accomplished the Y-configured dual stent assisted coil embolization. Follow-up angiogram at 30 months revealed no recanalization of aneurysm and patent blood flow of both PCAs. In conclusion, staged Y-shaped stents assisted coil embolization is an alternative treatment option in a wide-neck basilar tip aneurysm decreasing the extent of coil compaction of aneurysm and preserving an incorporated vessel.