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Dong L, Chen X, Wang J, Zhang L, Zhao Z, Peng Q, Liu P, Lv M. Neuroform atlas stent-assisted coiling of tiny wide-necked intracranial aneurysms. Front Neurol 2022; 13:1020785. [DOI: 10.3389/fneur.2022.1020785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022] Open
Abstract
ObjectiveTo investigate the safety and efficacy of Neuroform Atlas stent-assisted coiling for the treatment of tiny wide-necked intracranial aneurysms and evaluate risk factors associated with procedure-related complications.MethodsWe retrospectively examined 46 patients with 46 tiny wide-necked aneurysms who were treated using Atlas stent-assisted coiling at our institution from August 2020 to May 2022. Patient and aneurysm characteristics, procedural details, procedure-related complications, and angiographic and clinical outcomes were analyzed.ResultsA total of 10 patients presented with aneurysmal rupture. Atlas stent placement was successful in all patients. Angiography immediately after the procedure showed complete occlusion in 38 patients (82.6%), neck remnant in 7 (15.2%), and partial occlusion in 1 (2.2%). The mean angiographic follow-up was 8.4 months (range, 6–16). At the last follow-up, angiography showed complete occlusion in 41 patients (89.1%) and neck remnant in 5 (10.9%). No aneurysm recurrence or in-stent stenosis occurred. Incidence of procedure-related complications was 10.8% (intraprocedural aneurysm rupture, two cases; acute thrombosis, two cases; and coil migration, one case); only one patient (2.2%) experienced procedural neurological morbidity. The mean clinical follow-up was 9.7 months. A favorable outcome was achieved in 45 patients (97.8%). In univariate logistic regression analysis, aneurysm size (odds ratio, 4.538; P = 0.045) was significantly associated with procedure-related complications. However, multivariate analysis found no independent risk factors.ConclusionAtlas stent-assisted coiling of tiny wide-necked intracranial aneurysms is feasible and effective. Outcomes and occlusion rates are favorable and morbidity is low. The complication rate may be higher in larger tiny aneurysms.
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Çay F, Arat A. Effect of the Shelving Technique on the Outcome of Embolization in Intracranial Bifurcation Aneurysms. AJNR Am J Neuroradiol 2022; 43:1152-1157. [PMID: 35902123 PMCID: PMC9575423 DOI: 10.3174/ajnr.a7583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Stent bulging technique has been introduced as a technique that improves the outcome of aneurysm coiling. Our aim was to evaluate the utility of this technique, which involves the intentional herniation of stents into the bifurcation aneurysms during coiling. MATERIALS AND METHODS Unruptured bifurcation aneurysms treated by stent-assisted coiling using a single type of low-profile braided (LEO Baby) stent between November 2012 and October 2018 were retrospectively evaluated. The clinical (age and sex) and morphologic characteristics (aneurysm size, neck size, proximal/distal diameters of the stented artery, incorporation of the origins of the side branches to the aneurysm neck, and bifurcation angle) and response to antiplatelet therapy were evaluated. RESULTS Sixty-one patients (29 men, 47.5%; mean age, 55.95 [SD, 12.33] years) with 66 aneurysms were included. There were 36 aneurysms in group A (treated with the stent bulging technique) and 30 aneurysms in group B (treated by classic stent-assisted coiling). There was no significant difference in the patient and aneurysm characteristics in the groups except for the larger size and wider neck of the aneurysms in group A (P = .02 and P = .04, respectively). At the mean follow-up of 27.30 (SD, 17.45) months, there was no significant difference in the complication rate, the occlusion status, and the early and long-term occlusion rates between the groups. The stent bulging technique did not predict total occlusion (Raymond-Roy I) at the final imaging follow-up. CONCLUSIONS The stent bulging technique enables the coiling of larger, wide-neck aneurysms; however, we did not observe an added flow-diversion effect with the stent bulging technique compared with conventional stent-assisted coiling. We, therefore, suggest that bifurcation aneurysms should be coiled as densely and as safely as possible using this technique.
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Affiliation(s)
- F Çay
- From the Department of Radiology (F.Ç., A.A.), Hacettepe University School of Medicine, Ankara, Turkey
| | - A Arat
- From the Department of Radiology (F.Ç., A.A.), Hacettepe University School of Medicine, Ankara, Turkey .,TOBB ETU Medical School Hospital (A.A.), Ankara, Turkey
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McEachern J, Iancu D, van Adel B, Drake B, Kaderali Z, Spirou M, Lesiuk H, Weill A, Roy D, Raymond J, Hadziomerovic IS, Shankar J. Long term safety and effectiveness of LVIS Jr for treatment of intracranial aneurysms- a Canadian Multicenter registry. Interv Neuroradiol 2022; 29:134-140. [PMID: 35112888 PMCID: PMC10152819 DOI: 10.1177/15910199221077588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Low-profile Visible Intraluminal Support device (LVIS Jr) has become a commonly used intracranial stent for the treatment of intracranial aneurysms. However long-term stability and effectiveness remains to be seen. The purpose of the study was to assess the long-term efficacy, safety and durability of LVIS Jr. in a retrospective multicenter registry. METHODS Patients with saccular aneurysms treated at centers across Canada using LVIS Jr for intracranial aneurysms were included in this retrospective registry between the dates of January 2013 and April 2019. Self reported outcomes were collected and used to assess both perioperative and long term safety and effectiveness. Both univariate and multivariate analysis were performed. RESULTS Total of 196 patients (132 Women; mean age of 57.6 years) underwent endovascular aneurysm treatment with at least 1 LVIS Jr. stent. Mean aneurysm dome size was 7.4 mm, and mean neck size of 4.3 mm. Mean clinical and imaging follow up were 950 and 899 days respectively. Class I/II was achieved in 85% on long term follow up. Periprocedural morbidity and mortality was 4.6% and 2% and additional delayed morbidity and mortality was 3% and 2.5%. Aneurysm size >10 mm was independent predictor of periprocedural complication (OR 2.59, p = 0.048) while an increased dome to neck ratio >1.5 was independent predictor of increased delayed complications (OR 3.99, p = 0.02). CONCLUSION The LVIS Jr. intracranial stent is an effective device in the treatment of intracranial aneurysms. Satisfactory long term occlusion rates can be achieved safely with stent-assisted coil embolization.
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Affiliation(s)
- James McEachern
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Daniela Iancu
- Department of Radiology, 25443Centre hospitalier de'Universite de Montreal, Montreal, Canada
| | - Brian van Adel
- Division of Neurology, 3710McMaster University, Hamilton, Canada
| | - Brian Drake
- Division of Neurosurgery, University of Ottawa, Ottawa, Canada
| | - Zul Kaderali
- Division of Neurosurgery, University of Manitoba, Winnipeg, Canada
| | - Michael Spirou
- Department of Radiology, 25443Centre hospitalier de'Universite de Montreal, Montreal, Canada
| | - Howard Lesiuk
- Division of Neurosurgery, University of Ottawa, Ottawa, Canada
| | - Alain Weill
- Department of Radiology, 25443Centre hospitalier de'Universite de Montreal, Montreal, Canada
| | - Daniel Roy
- Department of Radiology, 25443Centre hospitalier de'Universite de Montreal, Montreal, Canada
| | - Jean Raymond
- Department of Radiology, 25443Centre hospitalier de'Universite de Montreal, Montreal, Canada
| | | | - Jai Shankar
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
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