Neuroradiology

, Volume 51, Issue 6, pp 401–409 | Cite as

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

  • Jacques Sedat
  • Yves Chau
  • Lydiane Mondot
  • Julian Vargas
  • Jacek Szapiro
  • Michel Lonjon
Interventional Neuroradiology

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.

Keywords

Intracranial aneurysm Endovascular Guglielmi detachable coils Neuroform Stent 

Notes

Conflict of interest statement

We declare that we have no conflict of interest.

References

  1. 1.
    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 PubMedCrossRefGoogle Scholar
  2. 2.
    Murayama Y, Nien YL, Duckwiler G et al (2003) Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 98:959–966PubMedGoogle Scholar
  3. 3.
    Brilstra EH, Rinkel GJ, van der Graaf Y et al (1999) Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke 30:470–476PubMedGoogle Scholar
  4. 4.
    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 21:1312–1314PubMedGoogle Scholar
  5. 5.
    Malek AM, Higashida RT, Phatouros CC et al (1999) Treatment of an intracranial aneurysm using a new three-dimensional-shape Guglielmi detachable coil: technical case report. Neurosurgery 44:1142–1144 (discussion 1144–1145). doi: 10.1097/00006123-199905000-00125 PubMedCrossRefGoogle Scholar
  6. 6.
    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 24:30–44PubMedGoogle Scholar
  7. 7.
    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 25:584–591PubMedGoogle Scholar
  8. 8.
    Benitez RP, Silva MT, Klem J et al (2004) Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery 54:1359–1367 (discussion 1368). doi: 10.1227/01.NEU.0000124484.87635.CD PubMedCrossRefGoogle Scholar
  9. 9.
    Broadbent LP, Moran CJ, Cross DT et al (2003) Management of neuroform stent dislodgement and misplacement. AJNR Am J Neuroradiol 24:1819–1822PubMedGoogle Scholar
  10. 10.
    Fiorella D, Albuquerque FC, Han P et al (2004) Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. Neurosurgery 54:6–16 (discussion 16–17). doi: 10.1227/01.NEU.0000097194.35781.EA PubMedCrossRefGoogle Scholar
  11. 11.
    Fiorella D, Albuquerque FC, Deshmukh VR et al (2006) Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysms. Neurosurgery 59:291–300 (discussion 291–300). doi: 10.1227/01.NEU.0000223650.11954.6C PubMedCrossRefGoogle Scholar
  12. 12.
    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 8:107–119Google Scholar
  13. 13.
    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 24:1192–1199PubMedGoogle Scholar
  14. 14.
    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 102:235–241PubMedCrossRefGoogle Scholar
  15. 15.
    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)PubMedCrossRefGoogle Scholar
  16. 16.
    Roy D, Milot G, Raymond J (2001) Endovascular treatment of unruptured aneurysms. Stroke 32:1998–2004. doi: 10.1161/hs0901.095600 PubMedCrossRefGoogle Scholar
  17. 17.
    Fiorella D, Albuquerque FC, Deshmukh VR et al (2005) Usefulness of the Neuroform stent for the treatment of cerebral aneurysms: results at initial (3–6-mo) follow-up. Neurosurgery 56:1191–1201 (discussion 1201–1192). doi: 10.1227/01.NEU.0000159645.86823.AF PubMedCrossRefGoogle Scholar
  18. 18.
    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 CrossRefGoogle Scholar
  19. 19.
    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 15:493–502PubMedGoogle Scholar
  20. 20.
    Hirabayashi M, Ohta M, Rufenacht DA et al (2003) Characterization of flow reduction properties in an aneurysm due to a stent. Phys Rev E Stat Nonlin Soft Matter Phys 68:021918. doi: 10.1103/PhysRevE.68.021918 PubMedGoogle Scholar
  21. 21.
    Lopes D, Sani S (2005) Histological postmortem study of an internal carotid artery aneurysm treated with the Neuroform stent. Neurosurgery 56:E416 (discussion E416). doi: 10.1227/01.NEU.0000147977.07736.66 PubMedCrossRefGoogle Scholar
  22. 22.
    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 26:1223–1231PubMedGoogle Scholar
  23. 23.
    Howington JU, Hanel RA, Harrigan MR et al (2004) The Neuroform stent, the first microcatheter-delivered stent for use in the intracranial circulation. Neurosurgery 54:2–5. doi: 10.1227/01.NEU.0000099370.05758.4D PubMedCrossRefGoogle Scholar
  24. 24.
    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 26:1751–1756PubMedGoogle Scholar
  25. 25.
    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 26:2573–2577PubMedGoogle Scholar
  26. 26.
    Wells-Roth D, Biondi A, Janardhan V et al (2005) Endovascular procedures for treating wide-necked aneurysms. Neurosurg Focus 18:E7. doi: 10.3171/foc.2005.18.2.8 PubMedCrossRefGoogle Scholar
  27. 27.
    Yahia AM, Gordon V, Whapham J et al (2008) Complications of Neuroform stent in endovascular treatment of intracranial aneurysms. Neurocrit Care 8:19–30. doi: 10.1007/s12028-007-9001-7 PubMedCrossRefGoogle Scholar
  28. 28.
    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 PubMedCrossRefGoogle Scholar
  29. 29.
    Vanninen R, Manninen H, Ronkainen A (2003) Broad-based intracranial aneurysms: thrombosis induced by stent placement. AJNR Am J Neuroradiol 24:263–266PubMedGoogle Scholar
  30. 30.
    Fiorella D, Thiabolt L, Albuquerque FC et al (2005) Antiplatelet therapy in neuroendovascular therapeutics. Neurosurg Clin N Am 16:517–540. doi: 10.1016/j.nec.2005.03.003 PubMedCrossRefGoogle Scholar
  31. 31.
    Standhardt H, Boecher-Schwarz H et al (2008) Endovascular treatment of unruptured intracranial aneurysms with Guglielmi detachable coils: short- and long-term results of a single-centre series. Stroke 39:899–904. doi: 10.1161/STROKEAHA.107.496372 PubMedCrossRefGoogle Scholar
  32. 32.
    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 PubMedCrossRefGoogle Scholar
  33. 33.
    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 PubMedCrossRefGoogle Scholar
  34. 34.
    Gurbel PA, Bliden KP, Hiatt BL et al (2003) Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation 107:2908–2913. doi: 10.1161/01.CIR.0000072771.11429.83 PubMedCrossRefGoogle Scholar
  35. 35.
    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 89:783–787PubMedGoogle Scholar
  36. 36.
    Matetzky S, Shenkman B, Guetta V et al (2004) Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction. Circulation 109:3171–3175. doi: 10.1161/01.CIR.0000130846.46168.03 PubMedCrossRefGoogle Scholar
  37. 37.
    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 27:1123–1128PubMedGoogle Scholar
  38. 38.
    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 27:1135–1139PubMedGoogle Scholar
  39. 39.
    Raymond J, Guilbert F, Weill A et al (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403. doi: 10.1161/01.STR.0000073841.88563.E9 PubMedCrossRefGoogle Scholar
  40. 40.
    Gauvrit JY, Caron S, Taschner CA et al (2008) Intracranial aneurysms treated with Guglielmi detachable coils: long-term imaging follow-up with contrast-enhanced magnetic resonance angiography. J Neurosurg 108:443–449. doi: 10.3171/JNS/2008/108/3/0443 PubMedCrossRefGoogle Scholar
  41. 41.
    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 25:1764–1767PubMedGoogle Scholar
  42. 42.
    Juszkat R, Nowak S, Smol S et al (2007) Leo Stent for endovascular treatment of broad-necked and fusiform intracranial aneurysms. Interventional Neuroradiol 13:255–269Google Scholar
  43. 43.
    Turk AS, Niemann DB, Ahmed A et al (2007) Use of self-expanding stents in distal small cerebral vessels. AJNR Am J Neuroradiol 28:533–536. doi: 10.3174/ajnr.A0713 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Jacques Sedat
    • 1
  • Yves Chau
    • 1
  • Lydiane Mondot
    • 1
  • Julian Vargas
    • 2
  • Jacek Szapiro
    • 2
  • Michel Lonjon
    • 2
  1. 1.Unité de Neurointerventionnelle, Hôpital St. RochCHU NiceNiceFrance
  2. 2.Service de NeurochirurgieCH BastiaBastiaFrance

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