Skip to main content
Top
Published in: Neuroradiology 6/2009

01-06-2009 | Interventional Neuroradiology

Endovascular occlusion of intracranial wide-necked aneurysms with stenting (Neuroform) and coiling: mid-term and long-term results

Authors: Jacques Sedat, Yves Chau, Lydiane Mondot, Julian Vargas, Jacek Szapiro, Michel Lonjon

Published in: Neuroradiology | Issue 6/2009

Login to get access

Abstract

Introduction

Coiling associated with placement of self-expandable intracranial stents has amplified the treatment of intracranial wide-necked aneurysms, but the durability of this treatment and the existence of delayed recurrence are not yet well known. The purpose of this report is to present our experience with the Neuroform Stent associated with coiling and to evaluate complications, effectiveness, and long-term results of this technique.

Methods

A retrospective study of 42 patients with wide-necked cerebral aneurysms treated with the Neuroform Stent was performed. Mean aneurysm size was 11.3 mm. Mean neck size was 5.33 mm. All patients were treated with coiling and stenting. Clinical and angiographic follow-up was available in 38 patients (90.5%). The overall follow-up time ranged from 6 months to 5 years (mean, 42 months), but most of the patients (92%) had a follow-up period superior to 1 year.

Results

Successful deployment of 41 stents (97%) was obtained. Permanent procedural morbidity was observed in only one patient (2.4%). Long-term complete aneurysmal occlusion was obtained in 27 patients (71%). Aneurysmal regrowth was observed in four patients (9.5%) on the first control angiogram. After the first control angiogram, no delayed recanalization or regrowth was observed. During the follow-up period, there were no hemorrhagic events, no delayed thrombosis, and no stent displacement.

Conclusion

Our results demonstrate the effectiveness of the technique, a small rate of procedural complications, and long-term tolerance of the Neuroform Stent. Despite some evidence of early aneurysmal recurrence, long-term durability of stent-assisted aneurysm occlusion is stable after the first year.
Literature
1.
go back to reference Molyneux A, Kerr R, Stratton I et al (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274. doi:10.1016/S0140-6736(02)11314-6 PubMedCrossRef Molyneux A, Kerr R, Stratton I et al (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274. doi:10.​1016/​S0140-6736(02)11314-6 PubMedCrossRef
2.
go back to reference Murayama Y, Nien YL, Duckwiler G et al (2003) Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 98:959–966PubMed Murayama Y, Nien YL, Duckwiler G et al (2003) Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 98:959–966PubMed
3.
go back to reference Brilstra EH, Rinkel GJ, van der Graaf Y et al (1999) Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke 30:470–476PubMed Brilstra EH, Rinkel GJ, van der Graaf Y et al (1999) Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke 30:470–476PubMed
4.
go back to reference Cloft HJ, Joseph GJ, Tong FC et al (2000) Use of three-dimensional Guglielmi detachable coils in the treatment of wide-necked cerebral aneurysms. AJNR Am J Neuroradiol 21:1312–1314PubMed Cloft HJ, Joseph GJ, Tong FC et al (2000) Use of three-dimensional Guglielmi detachable coils in the treatment of wide-necked cerebral aneurysms. AJNR Am J Neuroradiol 21:1312–1314PubMed
5.
6.
go back to reference Moret J, Cognard C, Weill A et al (1997) Reconstruction technique in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases. J Neuroradiol 24:30–44PubMed Moret J, Cognard C, Weill A et al (1997) Reconstruction technique in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases. J Neuroradiol 24:30–44PubMed
7.
go back to reference Alfke K, Straube T, Dorner L et al (2004) Treatment of intracranial broad-neck aneurysms with a new self-expanding stent and coil embolization. AJNR Am J Neuroradiol 25:584–591PubMed Alfke K, Straube T, Dorner L et al (2004) Treatment of intracranial broad-neck aneurysms with a new self-expanding stent and coil embolization. AJNR Am J Neuroradiol 25:584–591PubMed
9.
go back to reference Broadbent LP, Moran CJ, Cross DT et al (2003) Management of neuroform stent dislodgement and misplacement. AJNR Am J Neuroradiol 24:1819–1822PubMed Broadbent LP, Moran CJ, Cross DT et al (2003) Management of neuroform stent dislodgement and misplacement. AJNR Am J Neuroradiol 24:1819–1822PubMed
12.
go back to reference Henkes H, Bose A, Felber S et al (2002) Endovascular coil occlusion of intracranial aneurysms assisted by a novel self-expandable nitinol microstent (Neuroform). Interventional Neuroradiol 8:107–119 Henkes H, Bose A, Felber S et al (2002) Endovascular coil occlusion of intracranial aneurysms assisted by a novel self-expandable nitinol microstent (Neuroform). Interventional Neuroradiol 8:107–119
13.
go back to reference Wanke I, Doerfler A, Schoch B et al (2003) Treatment of wide-necked intracranial aneurysms with a self-expanding stent system: initial clinical experience. AJNR Am J Neuroradiol 24:1192–1199PubMed Wanke I, Doerfler A, Schoch B et al (2003) Treatment of wide-necked intracranial aneurysms with a self-expanding stent system: initial clinical experience. AJNR Am J Neuroradiol 24:1192–1199PubMed
14.
go back to reference Lylyk P, Ferrario A, Pasbon B et al (2005) Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms. J Neurosurg 102:235–241PubMedCrossRef Lylyk P, Ferrario A, Pasbon B et al (2005) Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms. J Neurosurg 102:235–241PubMedCrossRef
15.
go back to reference Biondi A, Janardhan V, Katz JM et al (2007) Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery 61:460–468 (discussion 468–469)PubMedCrossRef Biondi A, Janardhan V, Katz JM et al (2007) Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery 61:460–468 (discussion 468–469)PubMedCrossRef
18.
go back to reference Szikora I, Berentei Z, Kulcsar Z et al (2006) Endovascular treatment of intracranial aneurysms with parent vessel reconstruction using balloon and self expandable stents. Acta Neurochir (Wien) 148:711–723 (discussion 723). doi:10.1007/s00701-006-0785-6 CrossRef Szikora I, Berentei Z, Kulcsar Z et al (2006) Endovascular treatment of intracranial aneurysms with parent vessel reconstruction using balloon and self expandable stents. Acta Neurochir (Wien) 148:711–723 (discussion 723). doi:10.​1007/​s00701-006-0785-6 CrossRef
19.
go back to reference Wakhloo AK, Schellhammer F, de Vries J et al (1994) Self-expanding and balloon-expandable stents in the treatment of carotid aneurysms: an experimental study in a canine model. AJNR Am J Neuroradiol 15:493–502PubMed Wakhloo AK, Schellhammer F, de Vries J et al (1994) Self-expanding and balloon-expandable stents in the treatment of carotid aneurysms: an experimental study in a canine model. AJNR Am J Neuroradiol 15:493–502PubMed
22.
go back to reference Akpek S, Arat A, Morsi H et al (2005) Self-expandable stent-assisted coiling of wide-necked intracranial aneurysms: a single-center experience. AJNR Am J Neuroradiol 26:1223–1231PubMed Akpek S, Arat A, Morsi H et al (2005) Self-expandable stent-assisted coiling of wide-necked intracranial aneurysms: a single-center experience. AJNR Am J Neuroradiol 26:1223–1231PubMed
24.
go back to reference Higashida RT, Halbach VV, Dowd CF et al (2005) Initial clinical experience with a new self-expanding nitinol stent for the treatment of intracranial cerebral aneurysms: the Cordis Enterprise stent. AJNR Am J Neuroradiol 26:1751–1756PubMed Higashida RT, Halbach VV, Dowd CF et al (2005) Initial clinical experience with a new self-expanding nitinol stent for the treatment of intracranial cerebral aneurysms: the Cordis Enterprise stent. AJNR Am J Neuroradiol 26:1751–1756PubMed
25.
go back to reference Pumar JM, Blanco M, Vazquez F et al (2005) Preliminary experience with Leo self-expanding stent for the treatment of intracranial aneurysms. AJNR Am J Neuroradiol 26:2573–2577PubMed Pumar JM, Blanco M, Vazquez F et al (2005) Preliminary experience with Leo self-expanding stent for the treatment of intracranial aneurysms. AJNR Am J Neuroradiol 26:2573–2577PubMed
28.
go back to reference Yavuz K, Geyik S, Pamuk AG et al (2007) Immediate and midterm follow-up results of using an electrodetachable, fully retrievable SOLO stent system in the endovascular coil occlusion of wide-necked cerebral aneurysms. J Neurosurg 107:49–55. doi:10.3171/JNS-07/07/0049 PubMedCrossRef Yavuz K, Geyik S, Pamuk AG et al (2007) Immediate and midterm follow-up results of using an electrodetachable, fully retrievable SOLO stent system in the endovascular coil occlusion of wide-necked cerebral aneurysms. J Neurosurg 107:49–55. doi:10.​3171/​JNS-07/​07/​0049 PubMedCrossRef
29.
go back to reference Vanninen R, Manninen H, Ronkainen A (2003) Broad-based intracranial aneurysms: thrombosis induced by stent placement. AJNR Am J Neuroradiol 24:263–266PubMed Vanninen R, Manninen H, Ronkainen A (2003) Broad-based intracranial aneurysms: thrombosis induced by stent placement. AJNR Am J Neuroradiol 24:263–266PubMed
32.
go back to reference Gallas S, Drouineau J, Gabrillargues J et al (2008) Feasibility, procedural morbidity and mortality, and long-term follow-up of endovascular treatment of 321 unruptured aneurysms. AJNR Am J Neuroradiol 29:63–68. doi:10.3174/ajnr.A0757 PubMedCrossRef Gallas S, Drouineau J, Gabrillargues J et al (2008) Feasibility, procedural morbidity and mortality, and long-term follow-up of endovascular treatment of 321 unruptured aneurysms. AJNR Am J Neuroradiol 29:63–68. doi:10.​3174/​ajnr.​A0757 PubMedCrossRef
33.
go back to reference Lee DH, Arat A, Morsi H et al (2008) Dual antiplatelet therapy monitoring for neurointerventional procedures using a point-of-care platelet function test: a single-center experience. AJNR Am J Neuroradiol 29:1389–1394. doi:10.3174/ajnr.A1070 PubMedCrossRef Lee DH, Arat A, Morsi H et al (2008) Dual antiplatelet therapy monitoring for neurointerventional procedures using a point-of-care platelet function test: a single-center experience. AJNR Am J Neuroradiol 29:1389–1394. doi:10.​3174/​ajnr.​A1070 PubMedCrossRef
35.
go back to reference Muller I, Besta F, Schulz C et al (2003) Prevalence of clopidogrel non-responders among patients with stable angina pectoris scheduled for elective coronary stent placement. Thromb Haemost 89:783–787PubMed Muller I, Besta F, Schulz C et al (2003) Prevalence of clopidogrel non-responders among patients with stable angina pectoris scheduled for elective coronary stent placement. Thromb Haemost 89:783–787PubMed
37.
go back to reference Katsaridis V, Papagiannaki C, Violaris C (2006) Embolization of acutely ruptured and unruptured wide-necked cerebral aneurysms using the neuroform2 stent without pretreatment with antiplatelets: a single center experience. AJNR Am J Neuroradiol 27:1123–1128PubMed Katsaridis V, Papagiannaki C, Violaris C (2006) Embolization of acutely ruptured and unruptured wide-necked cerebral aneurysms using the neuroform2 stent without pretreatment with antiplatelets: a single center experience. AJNR Am J Neuroradiol 27:1123–1128PubMed
38.
go back to reference Hsu SW, Chaloupka JC, Feekes JA et al (2006) In vitro studies of the neuroform microstent using transparent human intracranial arteries. AJNR Am J Neuroradiol 27:1135–1139PubMed Hsu SW, Chaloupka JC, Feekes JA et al (2006) In vitro studies of the neuroform microstent using transparent human intracranial arteries. AJNR Am J Neuroradiol 27:1135–1139PubMed
41.
go back to reference Fiorella D, Albuquerque FC, Deshmukh VR et al (2004) In-stent stenosis as a delayed complication of neuroform stent-supported coil embolization of an incidental carotid terminus aneurysm. AJNR Am J Neuroradiol 25:1764–1767PubMed Fiorella D, Albuquerque FC, Deshmukh VR et al (2004) In-stent stenosis as a delayed complication of neuroform stent-supported coil embolization of an incidental carotid terminus aneurysm. AJNR Am J Neuroradiol 25:1764–1767PubMed
42.
go back to reference Juszkat R, Nowak S, Smol S et al (2007) Leo Stent for endovascular treatment of broad-necked and fusiform intracranial aneurysms. Interventional Neuroradiol 13:255–269 Juszkat R, Nowak S, Smol S et al (2007) Leo Stent for endovascular treatment of broad-necked and fusiform intracranial aneurysms. Interventional Neuroradiol 13:255–269
Metadata
Title
Endovascular occlusion of intracranial wide-necked aneurysms with stenting (Neuroform) and coiling: mid-term and long-term results
Authors
Jacques Sedat
Yves Chau
Lydiane Mondot
Julian Vargas
Jacek Szapiro
Michel Lonjon
Publication date
01-06-2009
Publisher
Springer-Verlag
Published in
Neuroradiology / Issue 6/2009
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-009-0502-2

Other articles of this Issue 6/2009

Neuroradiology 6/2009 Go to the issue