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Low-Profile Laser-Cut Stents for Endovascular Treatment of Intracranial Aneurysms

Incidence, Clinical Presentation and Risk Factors of Thromboembolic Events

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Abstract

Purpose

Low-profile intracranial stents are characterized by a miniaturized design that enables deployment via a 0.0165″ or 0.017″ internal diameter microcatheter, which is typically intended for coil delivery. This study analyzed the incidence, clinical relevance and risk factors of thromboembolic events (TEE) occurring during low-profile stent-assisted coiling of intracranial aneurysms.

Methods

This was a retrospective, multicenter analysis of consecutive patients who underwent stent-assisted aneurysm coiling (SAC) with the laser-cut Acandis Acclino and Neuroform Atlas stents. The study evaluated the incidence of symptomatic and asymptomatic TEEs and the impact on functional outcome. Risk factors for TEEs were determined by univariate and bivariate logistic regression analyses.

Results

Among 131 procedures (mean patient age 56.5 ± 12.8 years, mean aneurysm size: 6.7 ± 3.9 mm) TEEs occurred in 14 cases (10.7%) of which 2 patients (1.5%) developed ischemic stroke, while the remaining TEEs remained asymptomatic. Multivariate analysis revealed Y‑stenting as potential risk factor for TEEs (odds ratio: 3.9, 95% confidence interval: 1.0–16.5; p = 0.08).

Conclusion

The use of SAC with low-profile intracranial stents is associated with a favorable safety profile; however, Y‑stenting may carry an increased risk of TEEs, which needs to be considered during treatment planning.

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References

  1. Ansari SA, Lassig JP, Nicol E, Thompson BG, Gemmete JJ, Gandhi D. Thrombosis of a fusiform Intracranial aneurysm induced by overlapping neuroform stents case report. Neurosurgery. 2007;60:E950–1.

    Article  Google Scholar 

  2. Aydin K, Arat A, Sencer S, Barburoglu M, Men S. Stent-assisted coiling of wide-neck intracranial aneurysms using low-profile LEO baby stents: initial and midterm results. AJNR Am J Neuroradiol. 2015;36:1934–41.

    Article  CAS  PubMed  Google Scholar 

  3. Bartolini B, Blanc R, Pistocchi S, Redjem H, Piotin M. “Y” and “X” stent-assisted coiling of complex and wide-neck intracranial bifurcation aneurysms. AJNR Am J Neuroradiol. 2014;35:2153–8.

    Article  CAS  Google Scholar 

  4. Bechan R, Sprengers M, Majoie C, Peluso J, Sluzewski M, van Rooij W. Stent-assisted coil embolization of intracranial aneurysms: complications in acutely ruptured versus unruptured aneurysms. AJNR Am J Neuroradiol. 2016;37:502–7.

    Article  CAS  Google Scholar 

  5. Borggrefe J, Behme D, Mpotsaris A, Weber W. Complications associated with cerebral aneurysm morphology in balloon-assisted coil embolization of ruptured and unruptured aneurysms—a single-center analysis of 116 consecutive cases. World Neurosurg. 2016;91:483–9.

    Article  Google Scholar 

  6. Brassel F, Grieb D, Meila D, Schlunz-Hendann M, Greling B, Melber K. Endovascular treatment of complex intracranial aneurysms using acandis acclino stents. J Neurointerv Surg. 2017;9:854–9.

    Article  Google Scholar 

  7. Brassel F, Melber K, Schlunz-Hendann M, Meila D. Kissing‑Y stenting for endovascular treatment of complex wide necked bifurcation aneurysms using acandis acclino stents: results and literature review. J Neurointerv Surg. 2016;8:386–95.

    Article  Google Scholar 

  8. Cay F, Peker A, Arat A. Stent-assisted coiling of cerebral aneurysms with the neuroform atlas stent. Interv Neuroradiol. 2018;24:263–9.

    Article  Google Scholar 

  9. Chalouhi N, Jabbour P, Singhal S, Drueding R, Starke RM, Dalyai RT et al. Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke. 2013;44:1348–53.

    Article  Google Scholar 

  10. Chalouhi N, Tjoumakaris S, Gonzalez LF, Dumont AS, Starke RM, Hasan D et al. Coiling of large and giant aneurysms: complications and long-term results of 334 cases. AJNR Am J Neuroradiol. 2014;35:546–52.

    Article  CAS  Google Scholar 

  11. Chalouhi N, Zanaty M, Whiting A, Yang S, Tjoumakaris S, Hasan D et al. Safety and efficacy of the pipeline embolization device in 100 small intracranial aneurysms. J Neurosurg. 2015;122:1498–502.

    Article  Google Scholar 

  12. Chow MM, Woo HH, Masaryk TJ, Rasmussen PA. A novel endovascular treatment of a wide-necked basilar apex aneurysm by using a Y-configuration, double-stent technique. AJNR Am J Neuroradiol. 2004;25:509–12.

    PubMed  Google Scholar 

  13. Fargen KM, Hoh BL, Welch BG, Pride GL, Lanzino G, Boulos AS et al. Long-term results of enterprise stent-assisted coiling of cerebral aneurysms. Neurosurgery. 2012;71:239–44.

    Article  Google Scholar 

  14. Goertz L, Dorn F, Kraus B, Borggrefe J, Schlamann M, Forbrig R et al. Safety and efficacy of the derivo embolization device for the treatment of ruptured intracranial aneurysms. J Neurointervent Surg. 2018;11(3):290–5.

    Article  Google Scholar 

  15. Goertz L, Dorn F, Siebert E, Herzberg M, Borggrefe J, Schlamann M et al. Safety and efficacy of the neuroform atlas for stent-assisted coiling of intracranial aneurysms: a multicenter experience. J Clin Neurosci. 2019;68:86–91.

    Article  PubMed  Google Scholar 

  16. Goertz L, Liebig T, Siebert E, Herzberg M, Neuschmelting H, Borggrefe J et al. Risk factors of procedural complications related to woven endobridge (WEB) embolization of Intracranial aneurysms. Clin Neuroradiol. 2019; https://doi.org/10.1007/s00062-019-00762-8.

    Article  PubMed  Google Scholar 

  17. Goertz L, Smyk MA, Mpotsaris A, Borggrefe J, Dorn F, Liebig T et al. Long-term angiographic results of the low-profile acandis acclino stent for treatment of Intracranial aneurysms: a multicenter study. Clin Neuroradiol. 2019; https://doi.org/10.1007/s00062-019-00847-4.

    Article  PubMed  Google Scholar 

  18. Hetts SW, Turk A, English JD, Dowd CF, Mocco J, Prestigiacomo C, Nesbit G et al. Stent-assisted coiling versus coiling alone in unruptured intracranial aneurysms in the matrix and platinum science trial: safety, efficacy, and mid-term outcomes. AJNR Am J Neuroradiol. 2014;35:698–705.

    Article  CAS  Google Scholar 

  19. Hong Y, Wang YJ, Deng Z, Wu Q, Zhang JM. Stent-assisted coiling versus coiling in treatment of intracranial aneurysm: a systematic review and meta-analysis. PLoS One. 2014;9:e82311.

    Article  Google Scholar 

  20. Jahshan S, Abla AA, Natarajan SK, Drummond PS, Kan P, Karmon Y et al. Results of stent-assisted vs non-stent-assisted endovascular therapies in 489 cerebral aneurysms: single-center experience. Neurosurgery. 2012;72:232–9.

    Article  Google Scholar 

  21. Jankowitz BT, Hanel R, Jadhav AP, Loy DN, Frei D, Siddiqui AH et al. Neuroform atlas stent system for the treatment of intracranial aneurysm: primary results of the atlas humanitarian device exemption cohort. J Neurointerv Surg. 2019;11:801–6.

    Article  Google Scholar 

  22. Johnson AK, Munich SA, Tan LA, Heiferman DM, Keigher KM, Lopes DK. Complication analysis in nitinol stent-assisted embolization of 486 intracranial aneurysms. J Neurosurg. 2015;123:453–9.

    Article  Google Scholar 

  23. Kabbasch C, Goertz L, Siebert E, Herzberg M, Borggrefe J, Krischek B et al. WEB embolization versus stent-assisted coiling: comparison of complication rates and angiographic outcomes. J Neurointerv Surg. 2019;11:812–6.

    Article  Google Scholar 

  24. Kadkhodayan Y, Rhodes N, Blackburn S, Derdeyn CP, Cross DT, Moran CJ. Comparison of enterprise with neuroform stent-assisted coiling of intracranial aneurysms. AJR Am J Roentgenol. 2013;200:872–8.

    Article  Google Scholar 

  25. King B, Vaziri S, Singla A, Fargen KM, Mocco J. Clinical and angiographic outcomes after stent-assisted coiling of cerebral aneurysms with enterprise and neuroform stents: a comparative analysis of the literature. J Neurointervent Surg. 2015;7:905–9.

    Article  Google Scholar 

  26. Kraus B, Goertz L, Turowski B, Borggrefe J, Schlamann M, Dorn F et al. Safety and efficacy of the derivo embolization device for the treatment of unruptured intracranial aneurysms: a multicentric study. J Neurointerv Surg. 2018;11:68–73.

    Article  Google Scholar 

  27. Park KY, Kim BM, Kim DJ, Chung J, Lee JW. Y‑configuration stenting for coiling of wide-neck bifurcation aneurysms using low-profile visualized Intraluminal support junior. J Neurointerv Surg. 2019;11:400–4.

    Article  Google Scholar 

  28. Piotin M, Blanc R, Spelle L, Mounayer C, Piantino R, Schmidt PJ et al. Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke. 2010;41:110–5.

    Article  Google Scholar 

  29. Poncyljusz W, Biliński P, Safranow K, Baron J, Zbroszczyk M, Jaworski M et al. The LVIS/LVIS Jr. stents in the treatment of wide-neck intracranial aneurysms: multicentre registry. J Neurointervent Surg. 2015;7:524–9.

    Article  Google Scholar 

  30. Samaniego EA, Mendez AA, Nguyen TN, Kalousek V, Guerrero WR, Dandapat S et al. LVIS Jr device for Y‑stent-assisted coil embolization of wide-neck Intracranial aneurysms: a multicenter experience. Interv Neurol. 2018;7:271–83.

    Article  Google Scholar 

  31. Spiotta AM, Gupta R, Fiorella D, Gonugunta V, Lobo B, Rasmussen PA et al. Mid-term results of endovascular coiling of wide-necked aneurysms using double stents in a Y configuration. Neurosurgery. 2011;69:421–9.

    Article  Google Scholar 

  32. Tureli D, Sabet S, Senol S, Andac N, Donmez H, Geyik S et al. Stent-assisted coil embolization of challenging intracranial aneurysms: initial and mid-term results with low-profile ACCLINO devices. Acta Neurochir (Wien). 2016;158:1545–53.

    Article  Google Scholar 

  33. Ulfert C, Pham M, Sonnberger M, Amaya F, Trenkler J, Bendszus M et al. The neuroform atlas stent to assist coil embolization of intracranial aneurysms: a multicentre experience. J Neurointerv Surg. 2018;10:1192–6.

    Article  Google Scholar 

  34. Vergouwen MD, Vermeulen M, van Gijn J, Rinkel GJ, Wijdicks EF, Muizelaar JP et al. Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke. 2010;41:2391–5.

    Article  Google Scholar 

  35. Wanke I, Forsting M. Stents for intracranial wide-necked aneurysms: more than mechanical protection. Neuroradiology. 2008;50:991–8.

    Article  Google Scholar 

  36. Yang H, Sun Y, Jiang Y, Lv X, Zhao Y, Li Y et al. Comparison of stent-assisted coiling vs coiling alone in 563 intracranial aneurysms: safety and efficacy at a high-volume center. Neurosurgery. 2015;77:241–7.

    Article  Google Scholar 

  37. Zhao KJ, Yang PF, Huang QH, Li Q, Zhao WY, Liu JM et al. Y‑configuration stent placement (crossing and kissing) for endovascular treatment of wide-neck cerebral aneurysms located at 4 different bifurcation sites. AJNR Am J Neuroradiol. 2012;33:1310–6.

    Article  Google Scholar 

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Funding

This research received no specific grant from any funding agency in the public, commercial or not for profit sectors.

Author information

Authors and Affiliations

  1. Department of Neuroradiology, University Hospital of Cologne, Kerpener Str. 67, 50937, Cologne, Germany

    Lukas Goertz, Jan Borggrefe, Marc Schlamann & Christoph Kabbasch

  2. Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Str. 67, 50937, Cologne, Germany

    Lukas Goertz

  3. Department of Neuroradiology, University Hospital of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany

    Michael Artur Smyk & Bernd Turowski

  4. Institute of Neuroradiology, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Eberhard Siebert & Georg Bohner

  5. Department of Neuroradiology, University Hospital of Aachen, Pauwelsstr. 30, 52074, Aachen, Germany

    Anastasios Mpotsaris

  6. Department of Neuroradiology, LMU University Hospital of Munich, Marchioninistr. 15, 81377, Munich, Germany

    Franziska Dorn & Thomas Liebig

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  1. Lukas Goertz
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  11. Christoph Kabbasch
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Corresponding author

Correspondence to Lukas Goertz.

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Conflict of interest

L. Goertz, M.A. Smyk, E. Siebert, B. Turowski, J. Borggrefe, G. Bohner and M. Schlamann declare that they have no competing interests. F. Dorn served as consultant for Acandis. C. Kabbasch served as consultant for Acandis and as proctor for MicroVention Inc./Sequent Medical. T. Liebig served as proctor for MicroVention Inc./Sequent Medical, phenox, Medtronic, and Stryker. A. Mpotsaris served as consultant for Stryker.

Ethical standards

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. According to institutional guidelines, no ethics committee approval was required for this retrospective observational study. The manuscript does not contain any details that might disclose the identity of the patients.

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Goertz, L., Smyk, M.A., Siebert, E. et al. Low-Profile Laser-Cut Stents for Endovascular Treatment of Intracranial Aneurysms. Clin Neuroradiol 31, 107–115 (2021). https://doi.org/10.1007/s00062-019-00874-1

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