Clinical safety and efficacy of stent-assisted coil embolization with ACCERO stent in cerebral aneurysm: Short-term follow-up and precaution for use

Abstract

Objective: Stent-assisted coil embolization (SAC) is an effective method of treating intracranial aneurysms. The aim of the study was to assess the safety and efficacy of the new ACCERO stent for the treatment of cerebral aneurysms.

Methods: It was a retrospective, single-center study. Nine ruptured and 41 unruptured cerebral aneurysms were treated using the ACCERO stent between February 2021 and December 2023. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical outcomes were analyzed. Follow-up was conducted with magnetic resonance angiography (MRA) or Digital subtraction angiography (DSA) was performed 6 to 12 months after the procedure.

Results: The ACCERO stent deployment was attempted in 51 cases, with replacement by the Neuroform Atlas stent in 1 case. Successful stent deployment was achieved in 50 cases, and appropriate wall apposition to the parent artery. The average clinical follow-up period was 17.1 months. Intimal hyperplasia was observed in 1 case, but no other clinical complications related to the stent occurred. Favorable clinical outcomes were observed in 92% of patients (46/50), including those with subarachnoid hemorrhage. Immediate favorable angiographic outcomes and complete occlusion were achieved in 90% (45/50) and 74% (37/50) of cases, respectively. Among the 45 patients who had imaging follow-up, favorable angiographic outcomes and complete occlusion were observed in 93.3% (43/45) and 82.2% (37/45) of cases, respectively.

Conclusions: The ACCERO stent is a braided-type stent that requires more attention than stents, such as the Neuroform Atlas or Enterprise stents. However, since the struts of the stent are fully visible, it can be more useful in treating challenging aneurysms once the user becomes familiar with its use.

Keywords: ACCERO stent; Intracranial aneurysm; Stent-assisted coil embolization.

Fig. 1.

(A) A 55-year-old female patient, with subarachnoid hemorrhage observed on brain CT. (B) Embolization using the ACCERO stent was performed for ruptured ACoA aneurysm, and thrombus was observed in the proximal part of the stent (red arrow). (C) Intra-arterial tirofiban was used several times. (D) Ipsilateral ACA blood flow was significantly reduced due to thrombus. CT, computed tomography; AcoA, anterior communicating artery; ACA, anterior cerebral artery

Fig. 2.

(A) Embolization was performed using the ACCERO stent for an ophthalmic artery aneurysm. (B) MRA performed 6 months later showed a decrease in blood flow in the ipsilateral internal carotid artery. (C) Intimal hyperplasia within the ACCERO stent was observed using DSA. (D) MRA performed one year later confirmed the recovery of blood flow in the ipsilateral internal carotid artery. MRA, magnetic resonance angiography; DSA, digital subtraction angiography

Fig. 3.

(A) A very tiny ruptured anterior choroidal aneurysm was identified. (B, C) The ACCERO stent is a braided-type stent with a high strut density, which allowed for the safe treatment of very small coils. The coil used was a Target Helical 1×1 coil.”

Fig. 4.

(A) Treatment using the ACCERO stent was planned for the superior hypophyseal artery aneurysm. (B) When the ACCERO stent was deployed, the curvature of the parent artery straightened, causing a mismatch with the prepared road map. (C, D) The overall shape of the stent is clearly visible, with good wall apposition, and the aneurysm appears to be well occluded.

Fig. 5.

(A) Treatment using the ACCERO stent was planned for the paraclinoid aneurysm. (B) The ACCERO stent and the coil microcatheter competed within the parent artery, disrupting the wall apposition and neck coverage of the stent. (C) It was successfully treated by replacing the Neuroform Atlas with the ACCERO stent.