Results of Y-stent-assisted-coiling with a low-profile Neuroform Atlas stent in complex bifurcation aneurysms

Yıl 2022, Cilt: 5 Sayı: 5, 1366 - 1370, 25.09.2022

Bige Sayın , Ergün Dağlıoğlu

https://doi.org/10.32322/jhsm.1139782

Öz

Aim: Neuroform Atlas is a low-profile stent with an open-cell structure that can be deployed via a low-profile microcatheter. This study analyzed the safety, durability, and efficiency of Y-stent-assisted coiling (Y-SAC) with two Neuroform Atlas stents for treating unruptured wide-neck complex bifurcation aneurysms.
Material and method: We retrospectively reviewed patients who were treated for intracranial bifurcation aneurysms using the Y-SAC technique with two Neuroform Atlas stents. A total of 94 consecutive patients were included in the study. Clinical and angiographic results and complications were evaluated before and after the procedure.
Results: Y-SAC was successfully performed (100%) without any technical complications in any case. The mean angiographic follow-up period was 14.6±6.6 months. Follow-up DSA was performed on 93.6% of patients. The last follow-up angiograms demonstrated complete occlusion (RROC I) in 92%, and near-complete occlusion (RROC II) in 7% of the aneurysms. There was no mortality in this study. A procedure-related complication occurred in 4.2% of patients and caused permanent morbidity in 1% of patients.
Conclusion: In the endovascular treatment of wide-neck complex bifurcation aneurysms, the Y-SAC method with two Neuroform Atlas stents is safe and effective with high aneurysm occlusion rates and a low risk of procedural complications.

Anahtar Kelimeler

Cerebral aneurysm, treatment, embolization

Kaynakça

• Lopes DK, Johnson AK, Kellogg RG, Heiferman DM, Keigher KM. Long-term radiographic results of stent-assisted embolization of cerebral aneurysms. Neurosurgery 2014; 74: 286–91.
• Cohen JE, Melamed I, Itshayek E. X-microstenting and transmesh coiling in the management of wide-necked tent-like anterior communicating artery aneurysms. J Clin Neurosci 2014; 21: 664–7.
• Akmangit I, Aydın K, Sencer S, et al. Dual stenting using low-profile LEO baby stents for the endovascular management of challenging intracranial aneurysms. AJNR 2015; 36: 323–9.
• Chow MM, Woo HH, Masaryk TJ, Rasmussen PA. A novel endovascular treatment of a wide-necked basilar apex aneurysm by using a Y-configuration, double-stent technique. AJNR 2004; 25: 509–12.
• Aydin K, Balci S, Sencer S, Barburoglu M, Umutlu MR, Arat A. Y-stent-assisted coiling with low-profile Neuroform Atlas stents for endovascular treatment of wide-necked complex ıntracranial bifurcation aneurysms. Neurosurgery 2020; 87: 744–53.
• Akgul E, Aksungur E, Balli T, et al. Y-stent-assisted coil embolization of wide-neck intracranial aneurysms. a single-center experience. Interv Neuroradiol 2011; 17: 36–48
• Cagnazzo F, Limbucci N, Nappini S, et al. Y-stent-assisted coiling of wide-neck bifurcation intracranial aneurysms: a meta-analysis. AJNR 2019; 40: 122–8.
• Ciccio G, Robert T, Smajda S, et al. Double stent-assisted coiling of intracranial bifurcation aneurysms in Y and X configurations with the Neuroform Atlas stent: immediate and mid-term angiographic and clinical follow-up. J NeuroIntervent Surg 2019; 11: 1239–42.
• Kim D, Chung J. Y-stent-assisted coiling with Neuroform Atlas stents for wide-necked intracranial bifurcation aneurysms: A preliminary report. J Cerebrovasc Endovasc Neurosurg 2022; 24: 1–9.
• Raymond J, Roy D. Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery 1997; 41: 1235–46.
• Gory B, Spiotta AM, Mangiafico S, et al. Pulse rider stent-assisted coiling of wide-neck bifurcation aneurysms: periprocedural results in an international series. AJNR 2016; 37: 130–5.
• Spiotta AM, Derdeyn CP, Tateshima S, et al. Results of the ANSWER trial using the pulse rider for treating broad-necked, bifurcation aneurysms. Neurosurgery 2017; 81: 56–65.
• Chung J, Lim YC, Suh SH, et al. Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period: incidence of and risk factors for periprocedural complications. J Neurosurg 2014; 121: 4–11.
• Russo R, Bradac GB, Castellan L, et al. Neuroform Atlas stent-assisted coiling of ruptured intracranial aneurysms: a multicenter study. J Neuroradiol 2021; 48: 479–85.
• Spiotta AM, Gupta R, Fiorella D et al. Mid-term results of endovascular coiling of wide-necked aneurysms using double stents in a Y configuration. Neurosurgery 2011; 69: 421–9.
• Bartolini B, Blanc R, Pistocchi S, Redjem H, Piotin M. “Y” and “X” stent-assisted coiling of complex and wide-neck intracranial bifurcation aneurysms. AJNR 2014; 35: 2153–8.
• Granja MF, Cortez GM, Aguilar-Salinas P, et al. Stent-assisted coiling of cerebral aneurysms using the Y-stenting technique: a systematic review and meta-analysis. J NeuroIntervent Surg 2019; 11: 683–9.
• Goertz L, Smyk MA, Siebert E, et al. Low-profile laser-cut stents for endovascular treatment of intracranial aneurysms: incidence, clinical presentation and risk factors of thromboembolic events. Clin Neuroradiol 2021; 31: 107–15.
• Limbucci N, Renieri L, Nappinin S, Consoli A, Rosi A, Mangiafico S. Y-stent assisted coiling of bifurcation aneurysms with Enterprise stent: long-term follow up. J NeuroIntervent Surg 2016; 8: 158–62.
• Chalouhi N, Starke RM, Koltz MT, et al. Stent-assisted coiling versus balloon remodeling of wide-neck aneurysms: comparison of angiographic outcomes. AJNR 2013; 34: 1987–92.