A systematic review of the Contour Neurovascular System for the treatment of intracranial aneurysms

Abstract

BackgroundThis systematic review aims to reflect the current state of the literature on use and efficacy of the Contour Neurovascular System (CNS), an endovascular implant specifically developed for the treatment of intracranial wide-neck aneurysms.MethodsWe included manuscripts from a PubMed search with the terms "contour AND aneurysm." Manuscripts that did not refer to the CNS were excluded via screening.The number of interventions from included studies was calculated and, where possible, occlusion rates of aneurysms, used CNS sizes, and complications were recorded.ResultsWe found a total number of 23 studies with 625 patients and 661 aneurysms treated with CNS (122 ruptured). The number of studies with low bias and sufficient randomization is very small. Only two prospective studies with 43 patients could be identified. The mean aneurysm size was 6.4 mm (height), 5.5 mm (dome size), and 3.9 mm (neck size). Most used CNS sizes were "7" and "9." A complete occlusion result was achieved in 61% of patients in the long-term controls; in 28%, an adequate occlusion with a small neck rest was reported.ConclusionsThe preliminary results of the CNS are promising. However, these findings need to be proven in larger, prospective studies.

Keywords: Contour Neurovascular System; flow disruption; intracranial aneurysm; systematic review.

Figure 1.

A: schematic overview of the Contour Neurovascular device in an aneurysm of the anterior communicating cerebral artery. B–D (image courtesy of Stryker): Contour Neurovascular Device: possible configurations with a cup-like (B), funnel-like (C), or disc-like (D) shape.

Figure 2.

PRISMA flow chart of the included publications following the PubMed search “contour AND aneurysm.”

Figure 3.

Post-interventional imaging after implantation of a Contour Neurovascular Device into an aneurysm of the anterior communicating cerebral artery. (A) Digital subtraction angiography and (B) computed tomography angiography maximum intensity projection reconstruction. The radio-opaque marker of the device is marked with yellow arrows.

Figure 4.

Post-interventional imaging after implantation of a contour device into an aneurysm of the basilar tip. (Top) MR time-of-flight coronary maximum intensity projection reconstruction. (Bottom) MR time-of-flight angiography transversal. Notice the severe susceptibility artifacts caused by the contour device (yellow arrows).