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. 2023 Aug 16:14:1199390.
doi: 10.3389/fneur.2023.1199390. eCollection 2023.

Embolization of unruptured wide-necked aneurysms at the MCA bifurcation using the Neuroform atlas stent-assisted coiling: a two-center retrospective study

Xuexian Zhang  1 , Ruidong Wang  2 , Yuhan Ding  3 , Wei Li  1 , Hong Ren  2 , Jun Zhang  1
Affiliations

Embolization of unruptured wide-necked aneurysms at the MCA bifurcation using the Neuroform atlas stent-assisted coiling: a two-center retrospective study

Xuexian Zhang et al. Front Neurol. .

Abstract

Background: The management of middle cerebral artery (MCA) aneurysms remains a controversial topic, and MCA aneurysms have traditionally been treated primarily by surgical clipping. The Neuroform Atlas Stent™ (NAS, available from Stryker Neurovascular, Fremont, California) represents the latest generation of intracranial stents with improved stent delivery system capabilities.

Objective: This study aims to investigate the safety, feasibility and efficacy exhibited by NAS in treating unruptured aneurysms at the MCA bifurcation.

Methods: This was a two-center retrospective study involving 42 patients with unruptured wide-necked aneurysms (WNAs) of the MCA treated with the NAS from October 2020 to July 2022.

Results: The stent was used to treat 42 cases of unruptured WNA at the MCA bifurcation. Endovascular treatment techniques had a 100% success rate. Immediate postoperative angiography found complete aneurysm occlusion in 34 patients (80.9%) (mRRC 1), neck remnant in 7 patients (16.7%) (mRRC 2), and residual aneurysm in 1 patient (2.4%) (mRRC 3). The thromboembolic complication rate was 2.4% (1/42). The follow-up period was 8.7 months on average (3-16 months). The last angiographic follow-up results revealed complete aneurysm occlusion in 39 patients (92.9%) (mRRC 1), neck remnant in 3 (7.1%) patients (mRRC 2), no aneurysm recanalization or recurrence, and no cases of stent intimal hyperplasia. During the latest clinical follow-up, all patients had an mRS score of 0.

Conclusion: Our study demonstrates that the NAS can be applied to treat unruptured WNAs at the MCA bifurcation with favorable safety, feasibility, and efficacy.

Keywords: Neuroform atlas stent; aneurysm; bifurcation; middle cerebral artery; stent-assisted coiling.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Figures

Figure 1
Figure 1
Procedural and follow-up angiographic images of an adult patient with an unruptured wide-necked aneurysm at the right MCA bifurcation. (A) Preprocedural right internal carotid angiography image showing a wide-necked aneurysm at the MCA bifurcation (black arrow). (B) Preprocedural 3-dimensional reconstructed angiography image showing a saccular wide-necked MCA aneurysm (black arrow). (C) Intraoperative angiographic image shows Neuroform Atlas stent (black arrows) deployed into the inferior trunks of the MCA and coils (white arrow) inside the aneurysm. (D) Visualization of stent (white arrows) and coils (black arrow) under fluoroscopy. (E) Immediate postprocedural angiographic image showing complete embolization of the aneurysm (white arrow). (F) 9-month follow-up angiography demonstrating complete occlusion of the aneurysm (black arrow) with good branch preservation and no in-stent stenosis.
See this image and copyright information in PMC

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