Initial and mid-term results of LEO Baby stent-assisted coiling of intracranial aneurysms located in small arteries: A single-center experience with 131 consecutive patients

Clinical and Angiographic Outcomes of Intracranial Aneurysms Treated with Low-Profile Braided or Laser-Cut Stents: A Propensity Score-Matched Analysis

OBJECTIVE

To compare the embolization outcomes and complications of the LEO Baby and Neuroform Atlas stents in the endovascular treatment of intracranial wide-neck aneurysms.

METHODS

We identified patients with intracranial aneurysms treated with LEO Baby (n = 163) or Atlas (n = 65) stent-assisted coiling between October 2018 and February 2023. A retrospective analysis of demographics, aneurysm characteristics, embolization outcomes, and procedure-related complications was performed. Propensity score matching analysis with a ratio of 1:2 was used to balance the patient selection bias that existed between the 2 cohorts.

RESULTS

Compared to the Atlas cohort, the LEO Baby cohort had a higher rate of immediate successful embolization (95.6% vs. 78.5%, P < 0.001) and a lower rate of incomplete embolization at midterm follow-up (4.0% vs. 18.6%, P = 0.006), but there was no significant difference for either after matching for a 1:2 propensity score (P = 0.091 and P = 0.081, respectively). Procedure-related complications were 10.4% (17/163) in the LEO Baby cohort and 7.7% (5/65) in the Atlas cohort. At midterm angiographic follow-up, recanalization occurred in 0.8% (1/124) of the LEO Baby cohort and 4.7% (2/43) of the Atlas cohort. Complication and recanalization rates for both stents were not statistically different before (P = 0.701 and P = 0.332, respectively) and after (P > 0.999 and P > 0.999, respectively) propensity score matching.

CONCLUSIONS

Both LEO Baby and Atlas are safe and effective in the treatment of intracranial aneurysms, and they are similar in terms of aneurysm embolization outcomes and complication rates.

Preliminary outcomes of Neuroform Atlas stent-assisted coiling for intracranial aneurysms with small parent vessels

BACKGROUND

Although stent-assisted coiling has become a standard approach for treating intracranial aneurysms (IAs), there are limited reports on its safety and effectiveness in parent artery less than 2.5 mm in diameter. This study evaluates the feasibility, safety, and short-term outcomes of using Neuroform Atlas stent-assisted coiling for IAs with small parent vessels.

METHODS

This study reviewed and analyzed the clinical data of 50 IAs in 50 patients with a parent artery diameter of ≤ 2.5 mm, treated with Neuroform Atlas stent-assisted coiling at a single center between November 2020 and April 2024. Immediate postoperative angiographic outcomes were assessed using the modified Raymond-Roy classification. Follow-up imaging included computed tomographic angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA). Clinical outcomes were evaluated using the modified Rankin Scale (mRS).

RESULTS

The procedures achieved a 100% success rate. Immediately after treatment, 24 cases were classified as Raymond-Roy grade I, 11 as grade II, and 15 as grade III. Follow-up angiography in 28 cases revealed three instances of aneurysm recurrence, with a secondary procedure performed in one case. One patient reported poor neurological status, and two cases experienced procedure-related adverse events during telephone or clinical follow-up. Conclusions the Atlas stent demonstrated favorable outcomes in the treatment of aneurysms in small parent arteries (< 2.5 mm), with a low complication rate. The timely postoperative use of tirofiban may further reduce the risk of ischemic complications.

Treatment of saccular wide-neck intracranial aneurysm using Leo baby stent: a single-center experience based on 156 cases

To describe the mid-term safety and efficacy of Leo baby stent applied in saccular wide-neck intracranial aneurysms (IAs). 151 patients harboring 156 IAs treated with Leo baby stent from March 2021 to October 2023 were enrolled for further analysis. Among 156 IAs, 142 cases (91.0%) received one single Leo baby stent deployment while 14 cases (9.0%) received dual stents deployment. Stent-assisted coiling strategy was applied in all cases and the success rate was 100%. Immediate IAs occlusion results showed that 48 cases (30.8%) obtained Raymond grade I, 39 cases (25.0%) obtained Raymond grade II and 69 cases (44.2%) obtained Raymond grade III. Perioperative complications occurred in 10 cases (6.4%). Overall morbidity rate was 3.5% and mortality rate was 0% during follow-up. Clinical follow-up was available in 141 patients (93.4%). 136 patients (96.5%) got favorable clinical prognosis (mRS score 0-2) while 5 patients (3.5%) were in a poor neurological condition (mRS score 3-6). Angiographic follow-up was available in 136 cases (87.2%). The results showed that Raymond grade I was obtained in 112 cases (82.4%), Raymond grade II was obtained in 11 cases (8.1%) and Raymond grade III was obtained in 13 cases (9.6%). 4 cases (2.9%) were confirmed with IAs recurrence and received retreatment. Asymptomatic in-stent stenosis was detected in 8 patients (5.9%). The results demonstrate that stent-assisted coiling using Leo baby stent with favorable IAs embolization rate and the low complication rate is a feasible way in treating complex IAs.

Periprocedural thromboembolic complications of LEO baby stent in endovascular treatment of intracranial aneurysms: Experience in 149 patients

OBJECTIVE

To report periprocedural thromboembolic complications of LEO Baby stent-assisted coiling of wide-necked intracranial aneurysms and to analyze the possible influencing factors.

METHODS

We retrospectively identified 149 patients with aneurysms who underwent LEO Baby stent-assisted embolization between October 2018 and March 2022. Clinical and radiographic data of patients were reviewed to determine whether a thromboembolic event had occurred. Multivariate logistic analysis was performed to identify significant factors associated with thromboembolic events.

RESULTS

Successful stent deployment of the stent was achieved in all patients in the target artery. There were 66 patients (44.3%) with acutely ruptured aneurysms and 83 patients (55.7%) with unruptured aneurysms. Fourteen (9.4%, 95% confidence interval: 4.7%-14.1%) patients were confirmed to have developed a thromboembolic event, including nine patients with acute intraoperative thrombosis and five patients with postoperative thromboembolic events. The rate of thromboembolic events was 6.0% (5/83) in patients with unruptured aneurysms and 13.6% (9/66) in patients with acutely ruptured aneurysms. There was a trend toward an increased rate of thromboembolic events in patients with acute ruptured aneurysms (p = 0.087). Thromboembolic events were significantly associated with the parent-artery diameter (p = 0.010).

CONCLUSIONS

Our study demonstrates a low rate of thromboembolic complications in unruptured aneurysms treated with LEO Baby stent. Thromboembolic events appear to be more common in ruptured aneurysms. A small diameter of the parent artery is associated with an increased risk of thromboembolic complications, and more relevant studies are still needed.

Predictors of Perioperative Complications During Leo Baby Stent Treatment for Acutely Ruptured Intracranial Aneurysms: A Retrospective Multicenter Study

BACKGROUND AND OBJECTIVES

Stent-assisted coiling (SAC) of acutely ruptured aneurysms has been controversial. Moreover, for aneurysms originating from small diameter vessels, the SAC presents more challenges. This study aimed to investigate the predictors of perioperative complications after SAC with Leo baby stent of acutely ruptured aneurysms.

METHODS

We performed a retrospective multicenter analysis of 425 patients with acutely ruptured aneurysms treated with Leo baby. We compared clinical characteristics and outcomes among patients with perioperative complications and those without. Subgroup analysis, including thromboembolic and hemorrhagic complications, was also performed.

RESULTS

Immediate postoperative angiograms showed Raymond 1 in 357 aneurysms (84.2%), 2 in 53 (12.5%), and 3 in 14 (3.3%). A total of 372 patients (87.5%) were independent (modified Rankin Scale [mRS] score 0-2) at discharge. Perioperative complications occurred in 18 cases (4.2%) harboring 13 cases (3.1%) of thromboembolic complications and 5 cases (1.2%) of hemorrhagic complications. Patients with perioperative complications had a higher rate of unfavorable outcomes at discharge (P = .018), especially with thromboembolic complications (P = .043). Multivariate analysis showed that higher preoperative mRS score (P = .004), irregular shape (P = .017), and larger aneurysms (P = .049) were independent predictors of the overall complications, whereas higher preoperative mRS score (P = .022) was an independent predictor for ischemic complications. The follow-up angiogram was available for 245 patients, and the follow-up angiograms revealed Raymond 1 in 223 aneurysms (91.0%), 2 in 19 (7.8%), and 3 in 3 (1.2%).

CONCLUSION

Worse clinical condition, irregular shape, and larger aneurysms were independently associated with overall complications, whereas worse clinical condition was viewed as an independent predictor for thromboembolic complications. Attention to these factors is essential for the safe treatment and prognosis of patients with acutely ruptured aneurysms.

Use of the Neuroform Atlas stent for wide-necked cerebral aneurysms

To investigate the effect and safety of the Neuroform Atlas (NFA) stent in stent-assisted coiling of wide-necked intracranial aneurysms, patients with wide-necked intracranial aneurysms were retrospectively enrolled and treated with the NFA stent-assisted coiling. The modified Rankin scale (mRS) grades and Raymond grades were used to assess the clinical outcomes and aneurysm occlusion degrees, respectively, after embolization and at follow-up. Totally, 122 patients were enrolled with 129 wide-necked aneurysms, and forty-nine (40.2%) patients experienced subarachnoid hemorrhage. A total of 134 NFA stents were deployed in all patients. Immediately after endovascular embolization, the Raymond grade was I in 112 (86.8%), II in 8 (6.2%), and III in 9 (7.0%). Complications occurred in 7 (5.7%) patients, including stent displacement in 2 (1.6%) patients, thrombosis and cerebral infarction in 4 (3.3%), and death in 1 (0.8%). Clinical follow-up was performed in 113 (92.6%) patients 6-30 (mean 21) months after embolization, with the mRS grade 0 in 99 (87.6%) patients, 1 in 7 (6.2%), 2 in 5 (4.4%), and 3 in 2 (1.8%). Good prognosis (mRS ≤ 2) was achieved in 111 (98.2%) patients while poor prognosis (mRS > 2) in two (1.8%). Digital subtraction angiography was conducted in 98 (80.3%) patients with 104 (80.6%) aneurysms 6-30 (mean 21) months after embolization. The Raymond grade was grade I in 94 (90.4%) aneurysms, II in 4 (3.8%), and III in 6 (5.8%). Compared with the Raymond grades immediately after embolization, 93 (89.4%) aneurysms disappeared, 9 (8.7%) remained unchanged in the occlusion status, and 2 (1.9%) were recurrent. In conclusion, the NFA stent may have a high aneurysm occlusion rate and a low complication rate in assisting coiling of wide-necked intracranial aneurysms even though further studies are necessary to prove this.