Embolization of acutely ruptured and unruptured wide-necked cerebral aneurysms using the neuroform2 stent without pretreatment with antiplatelets: a single center experience

BACKGROUND AND PURPOSE: The Neuroform2 stent has been increasingly used in the stent-assisted coiling of wide-necked cerebral aneurysms, mostly after pretreatment with antiplatelet drugs. We retrospectively analyzed our results of stent-assisted coiling without pretreatment with antiplatelets. METHODS: We used 50 Neuroform2 stents in the treatment of 54 aneurysms without pretreatment with antiplatelets. Anticoagulation included intraprocedural heparin, nadroparin for 3 days, clopidogrel for 3 months, and aspirin for 6 months. RESULTS: Forty-nine stents were successfully deployed, and 52 of 54 aneurysms coiled (51 totally occluded and 1 subtotally). There was only one case of intraprocedural thrombus formation that was easily treated with recombinant tissue plasminogen activator. No serious hemorrhagic complications occurred during the follow-up period, and all 18 patients whose aneurysms have been controlled with angiography were found to have patent stents without stenosis and no aneurysm recanalization. No aneurysm rebleeding has occurred. CONCLUSION: We believe that stent-assisted coiling with the Neuroform2 stent is very effective and safe without pretreatment with antiplatelets in ruptured as well as in unruptured aneurysms.     

Treatment of a wide-necked aneurysm of the anterior cerebral artery using two Enterprise stents in “Y”-configuration stenting technique and coil embolization: a technical note

The endovascular treatment of wide-necked aneurysms remains challenging. The “Y”-stenting technique has been used for stent-assisted coil embolization of wide-necked bifurcation aneurysms. So far, this technique has been described for aneurysms of the basilar apex or the middle cerebral artery bifurcation and only for open stent systems using the Neuroform stent. We report a 52-year-old woman with recurrence of a wide-necked aneurysm of the anterior cerebral artery that was successfully retreated by stent-assisted coiling using the “Y”-stenting technique with the Enterprise stent system.     

Neuroform3支架辅助弹簧圈栓塞脑宽颈动脉瘤的长期随访疗效

目的评价Neuroform3支架辅助弹簧圈栓塞脑宽颈动脉瘤的长期随访疗效。方法2007年至2011年应用Neuroform3支架辅助弹簧圈栓塞118例脑动脉瘤,其中86例为破裂出血性动脉瘤,32例为未破裂动脉瘤,76例在出血72 h内实施了治疗。术后对患者进行脑血管造影和临床随访。结果支架准确释放115例(97.5%),因为血管扭曲和痉挛失败植入支架1例,支架移位2例。实施单纯支架植入2例,采用微导管经支架网眼技术66例,支架后释放技术49例。术后即刻造影示动脉瘤完全栓塞87例(74.4%),次全栓塞30例(25.6%)。术中无动脉瘤破裂出血事件发生,术后症状性脑梗死3例,无症状性脑梗死5例。术后随访6～60个月,平均26.8个月,共随访到105例,复查1～5次脑血管造影,完全栓塞99例(84.6%),次全栓塞病例中11例(36.7%)存在血栓形成;9例(7.7%)瘤体复发,其中5例进行了再次治疗达到完全栓塞,术后所有患者均无再出血,除3例外,所有患者支架内无明显狭窄。结论 Neuroform3支架辅助弹簧圈栓塞脑宽颈动脉瘤安全、有效,仍需更长期的随访和多中心研究。     

Neuroform支架辅助弹簧圈填塞治疗颅内宽颈动脉瘤

目的 探讨 Neuroform支架辅助弹簧圈填塞治疗颅内宽颈动脉瘤的技术,并评价临床疗效和并发症.方法 采用Neuroform支架辅助技术对31例颅内宽颈动脉瘤进行了弹簧圈填塞治疗.31例患者共有颅内动脉瘤43枚,均为破裂动脉瘤,其中39枚为宽颈动脉瘤,21枚颈:体≥1,18枚颈:体<1;4枚为宽颈动脉瘤患者合并的非宽颈动脉瘤.结果 31例患者共置入支架35枚,其中3例患者两侧颈内动脉各置入1枚支架,1例两侧大脑中动脉各置入1枚.43枚动脉瘤中41枚进行了不同程度的填塞,2枚末行填塞.2例宽颈动脉瘤患者置入支架后出现非动脉瘤破裂性出血,均可能由于输送导丝损伤大脑中动脉分支引起;1例后交通动脉瘤患者,弹簧圈飘至大脑中动脉M2段,引起相应脑缺血症状.获随访的29例中无死亡病例和再次出血病例,28例生存良好,1例留有明显神经功能障碍.结论 支架辅助技术进行弹簧圈填塞治疗颅内宽颈动脉瘤是安全、有效的临床技术,可以拓宽颅内动脉瘤治疗的适应证.     

Neuroform颅内支架辅助栓塞宽颈颅内动脉瘤的初步经验

目的　报道我科使用Neuroform支架辅助可脱式弹簧圈栓塞宽颈脑动脉瘤的初步经验。方法　 2 2例 2 4枚宽颈颅内动脉瘤采用Neuroform支架和弹簧圈进行栓塞 ,其中急性破裂动脉瘤 19枚、未破裂动脉瘤 5枚。结果　支架均成功地释放 ,支架置入后的造影未发现有瘤内造影剂滞留的血流动力学改变。 10 0 %闭塞动脉瘤 18枚 ,90 %以上闭塞 5枚 ,1枚伴发的未破裂小型宽颈动脉瘤在支架置入后微导管无法超选 ,载瘤动脉均通畅。有 2枚动脉瘤虽有支架阻挡 ,但仍有部分弹簧圈畔进入载瘤动脉。所有患者没有出现与支架置入有关的症状性缺血性并发症。 17例造影随访中 ,有 1例在 3个月复查时发现再通 ,进行 2次栓塞完全闭塞动脉瘤 ,其余未见复发 ,结论　Neuroform颅内支架使用安全有效 ,适合于宽颈颅内动脉瘤的支架辅助弹簧圈栓塞 ,特别适合于迂曲的脑血管 ;其径向支撑力较差 ,在输送微导管时应防止其移位 ;其支架网眼较大 ,对血流动力学改变不明显 ,致密填塞是重要的 ,在输送弹簧圈时仍应防止弹簧圈畔进入载瘤动脉 ;术前、术后抗血小板药物的应用以及术后严格的系列造影随访是必要的。     

Linear stent-assisted coiling: another way to treat very wide-necked intracranial aneurysms

We report a new technique of “linear” stent-assisted coiling for the endovascular treatment (EVT) of a large and very wide-necked unruptured middle cerebral artery (MCA) bifurcation aneurysm in a 45-year-old man. Two self-expandable stents were delivered within the MCA bifurcation branches with both proximal stent ends facing each other within the MCA bifurcation. Thanks to this linear stents placement, complete aneurysm neck coverage was obtained in order to safely coil the sac.     

Horizontal Neuroform stent deployment for a ruptured basilar terminus aneurysm via the posterior communicating artery

The authors describe the endovascular management of a ruptured wide-necked basilar terminus aneurysm with stent-assisted coil technique via posterior communicating collateral vessels from the anterior cerebral circulation. A Neuroform stent was placed horizontally across the neck of the aneurysm with use of the patient's large, patent, posterior communicating artery. This approach allowed for complete endovascular treatment in the setting of acute subarachnoid hemorrhage.     

Stent-assisted coil embolization of intracranial wide-necked aneurysms

The endovascular treatment of cerebral aneurysms with coils poses significant technical challenges, particularly with respect to wide-necked aneurysms. We present the results of our initial experiences in using a stent for endovascular treatment of aneurysms, with an emphasis on potential applications, technical aspects, and associated complications. Twenty-three wide-necked aneurysms from 22 patients were treated during the 13-month study period. Seven patients presented with subarachnoid hemorrhage. Aneurysms were located at the internal carotid artery (n=14), the vertebral artery (n=3), the basilar artery (n=5), and the middle cerebral artery (n=1). A Neuroform stent² was used for stent-assisted procedures. Premedication with antithrombotic agents was available for unruptured cases. Postprocedural antithrombotic medication was prescribed for all patients. Nineteen aneurysms were primarily stented, followed by coil placement. For five of these aneurysms, stenting was performed subsequent to failure of an attempt to frame with an initial coil. Stenting for the remaining four aneurysms was performed as a rescue procedure to prevent the migration of previously placed coils. Complete occlusion was obtained in ten aneurysms, nearly complete occlusion (95% or more occluded) in 11 aneurysms, and partial occlusion (less than 95% occluded) in one aneurysm. In one aneurysm, we failed to navigate the microcatheter into the aneurysmal sac through the interstices of the stent. Stent thrombosis was noted during the procedure in one patient. Hemorrhagic complication on the 25th day after the procedure was noted in one patient. No procedure-related complications were observed during the procedure or during follow-up in the remaining 20 patients, including seven patients who did not receive antithrombotic agents prior to endovascular treatment owing to recent subarachnoid hemorrhage. To overcome the technical limitation in the coiling of wide-necked aneurysms, stent-assisted coil embolization may be a technically feasible and relatively safe method, even though longer periods of follow-up are required.     

颅内宽颈动脉瘤的血管内治疗33例分析

目的总结应用颅内支架或球囊辅助技术治疗颅内宽颈动脉瘤的体会。方法应用颅内支架或球囊辅助瘤颈成形术结合Microplex弹簧圈栓塞治疗颅内破裂宽颈动脉瘤33例。动脉瘤位于前交通动脉8例,后交通动脉19例,大脑中动脉3例,基底动脉顶端3例。结果以支架辅助治疗的19例动脉瘤中13例完全致密填塞,4例填塞90％以上,2例大部填塞（70％～90％）。以球囊辅助治疗的14例动脉瘤中9例完全致密填塞,3例填塞90％以上,2例大部填塞。结论支架或球囊辅助治疗颅内宽颈动脉瘤是安全、有效的方法,两种方法各有优缺点,应根据动脉瘤的具体情况来选择采用支架或球囊治疗。     

支架结合弹簧圈在栓塞颅内复杂动脉瘤中的应用

目的 探讨支架结合弹簧圈在栓塞颅内复杂动脉瘤中的应用价值以及急性期使用支架的安全性.资料与方法 29例患者,32个动脉瘤.采用Neuroform支架,弹簧圈主要采用Matrix、Orbit圈,分析栓塞效果.急性期支架辅助栓塞宽颈动脉瘤20例.择期栓塞患者术前3天予以强抗血小板聚集药物,所有患者术后予强抗血小板聚集药物及5天抗凝治疗.术后复查21例.结果 所有病例栓塞操作均顺利完成,无手术并发症;除1例巨大动脉瘤为次全栓塞外,其他均致密栓塞.其中1枚支架覆盖2个动脉瘤并栓塞3例,支架辅助栓塞巨大宽颈动脉瘤3例,支架置入行二期动脉瘤颈残留弹簧圈再栓塞2例,动脉瘤常规弹簧圈栓塞后3年复发再以支架辅助栓塞1例.急症支架辅助微弹簧圈栓塞动脉瘤未发现支架内血栓形成或狭窄堵塞.复查21例中,除1例次全栓塞的巨大动脉瘤出现动脉瘤腔部分显影外,其余20例均未见动脉瘤显影.结论 支架结合不同型号弹簧圈栓塞有助于提高颅内复杂动脉瘤的治疗成功率;急性期可以使用支架,但在未行抗血小板聚集药物准备的前提下,其安全性有待进一步研究.     

Delayed coil migration from a small wide-necked aneurysm after stent-assisted embolization: case report and literature review

Introduction We present a previously unreported complication following the treatment of a patient with two small, wide-necked, posterior communicating artery aneurysms.Methods Endovascular embolization of one aneurysm was performed using a stent-assisted technique. Follow-up angiography 5 months later revealed that a coil had escaped the confinement of the stent and migrated distally without occluding any arterial branches or causing symptoms. This case report demonstrates that although a rare occurrence, a coil can break loose from the stent.Discussion We discuss the potential mechanisms of this phenomenon and review the literature on stent-assisted aneurysm coiling in order to raise awareness of this event when embolizing small, wide-necked aneurysms with a stent-assisted technique.     

Use of self-expanding stents in distal small cerebral vessels

BACKGROUND: Previously, endovascular treatment of wide-necked aneurysms and stenosis involving small vessels measuring <2 mm in diameter was limited. There are no reports in the literature addressing stent placement in small distal cerebral vessels. Recent experience with the Neuroform stent has shown that this device can be safely and effectively used to treat aneurysms in vessels of this caliber. MATERIALS AND METHODS: We report 8 cases of Neuroform stent placement into cerebral vessels measuring <2 mm in diameter (range, 1.1-1.8 mm). All stents were placed for aneurysm treatment in conjunction with coiling. Lesion locations and number were as follows: anterior communicating artery region (n = 5), pericallosal artery A2-A3 (n = 1), middle cerebral artery (MCA) M1-M2 (n = 1), and MCA M3-M4 (n = 1). Clinical follow-up ranged from 4.5 to 18 months. Imaging follow-up was performed with MR imaging/MR angiography. RESULTS: All procedures were successfully performed without immediate or delayed device-related complications. Intraprocedural thrombus developed within the stent in 2 patients and immediately resolved with 10 mg of intra-arterial abciximab. Follow-up at 18 months demonstrated durable results. There were no clinical neurologic symptoms related to the treated vessel territory at follow-up. CONCLUSION: Development of newer low-profile endovascular devices allows access and ability to treat lesions farther out in the smaller cerebral vessels. We have safely and successfully treated 8 vessels smaller than 2 mm in diameter with newer self-expanding stents with good short- and intermediate-term results. Further follow-up and more experience are necessary to determine long-term results.     

Neuroform EZ支架治疗颅内动脉瘤安全有效性单中心观察

目的探讨Neuroform EZ支架治疗颅内动脉瘤的安全性和有效性。方法回顾性分析2016年7月至2018年7月解放军总医院第一医学中心采用Neuroform EZ支架辅助栓塞治疗的39例(41枚)颅内动脉瘤患者临床资料。根据术后即刻和复查DSA造影,评价Neuroform EZ支架在辅助动脉瘤栓塞中的安全有效性。结果 41枚动脉瘤中破裂13枚(31.7%),未破裂28枚(68.3%)。共应用Neuroform EZ支架47枚,均准确释放(100%)。其中单枚支架辅助栓塞35枚,双支架辅助栓塞6枚(双支架套叠4枚,Y形支架2枚)。栓塞后即刻mRaymond分级1级19枚(46.3%),2级7枚(17.0%),3a级11个枚(26.8%),3b级4枚(9.6%),其中破裂、未破裂动脉瘤分别为1级10枚(76.9%)、9枚(32.1%)。术中发生血栓事件1枚(2.4%)。术后6个月复查造影显示,mRaymond分级改善13枚,变差2枚,发现载瘤动脉再狭窄1枚(2.4%)。结论 Neuroform ZE支架辅助弹簧圈栓塞颅内动脉瘤安全有效,仍需多中心研究和远期随访验证。     

Neurovascular Neck-Bridging device in treatment of wide-necked splenic artery aneurysms

We report the cases of 2 female patients, 45-year-old and 49-year-old, affected by wide-necked splenic aneurysm. We embolized the 2 lesions assisted by a new scaffolding neurovascular device, the Cascade Net, an innovative –occlusive remodeling device for temporary bridging in endovascular coil embolization of intracranial aneurysms. Visceral artery aneurysms are rare with an estimated prevalence of 2%-3% in imaging series and up to 10% in autopsy series. Most are asymptomatic and their diagnosis is occasionally. Aneurysm spontaneous rupture has been demonstrated in 2%-10% of cases and it can result in significant morbidity and mortality. Conservative management and open repair were the preferred treatment options for many years. Endovascular repair has been increasingly used since 2000; and the most widespread method of treatment has been coiling. Because of tortuosity of the parent artery, wide neck, and unfavorable locations at arterial branch points, 6% of Visceral and renal artery aneurysms VRAA cannot be adequately treated by simple coiling and requires parent artery remodeling through balloon occlusion, stent placement or parent vessel occlusion, leading to, in the latter situation, a compromised organ perfusion. Increasingly, balloon-assisted, and stent-assisted approaches as well as novel scaffolding neurovascular devices such as the Cascade Net, have allowed wide necked aneurysms to be bridged during endovascular treatment with smaller delivery system, averting parent artery occlusion and risk of distal embolization.     

Onyx联合支架辅助弹簧圈治疗复杂性颅内破裂动脉瘤

目的 探讨应用Onyx联合支架辅助弹簧圈治疗颅内复杂破裂动脉瘤的可行性和疗效.方法 回顾性分析2例应用Onyx联合支架辅助弹簧圈技术方法,进行治疗的颅内复杂破裂动脉瘤.并对Onyx栓塞治疗颅内动脉瘤相关文献进行回顾.结果 应用该技术栓塞治疗2例复杂性颅内动脉瘤(1例为右侧颈内动脉分叉部动脉瘤,1例为颈内动脉前壁复发动脉...     

Neuroform支架或球囊辅助弹簧圈栓塞颅内宽颈动脉瘤的对比研究

目的:通过对比分析207例Neuroform支架或球囊辅助弹簧圈栓塞的颅内宽颈动脉瘤,为临床选用Neuroform支架或球囊辅助弹簧圈栓塞颅内宽颈动脉瘤提供参考.方法:207例颅内宽颈动脉瘤中,129例采用Neuroform支架辅助弹簧圈栓塞,78例采用球囊辅助弹簧圈栓塞.术后3个月-5年进行改良Rankin量表评分....     

In-stent stenosis as a delayed complication of neuroform stent-supported coil embolization of an incidental carotid terminus aneurysm

The Neuroform stent is the first microcatheter-delivered stent designed specifically for the treatment of cerebral aneurysms. The stent functions primarily to provide durable parent vessel protection during the embolization of broad-necked cerebral aneurysms. The present case report demonstrates in-stent stenosis occurring as a delayed complication of Neuroform stent-supported coil embolization of an unruptured cerebral aneurysm.     

Stent-assisted coil embolization of wide-necked renal artery bifurcation aneurysms

PURPOSE: To report preliminary results of stent-assisted coil embolization in the treatment of wide-necked renal artery bifurcation aneurysms. MATERIALS AND METHODS: Four patients (three women, one man; mean age, 54 years; range, 49-67 y) with wide-necked renal artery aneurysms were treated with dedicated neurointerventional self-expanding nitinol stent-assisted coil embolization during a 2-year period. The stent was delivered over the neck of the aneurysm, after which the aneurysm was filled with detachable coils through a microcatheter placed into the aneurysm through the stent mesh. RESULTS: Stent delivery and coil embolization was successfully completed in all cases. Complete aneurysm occlusion without coil protrusion or arterial flow compromise was obtained in all patients. A small peripheral subsegmental renal infarction necessitating no therapy was registered in one patient on postembolization computed tomography. At follow-up angiography 1 year after embolization, no aneurysm recanalization or arterial obstruction was registered. CONCLUSIONS: Our preliminary experience indicates that stent-assisted coil embolization is technically feasible and effective for the exclusion of challenging renal artery bifurcation aneurysms without the sacrifice of any branch arteries.     

Self-expandable stent-assisted coiling of wide-necked intracranial aneurysms: a single-center experience

BACKGROUND AND PURPOSE: Endovascular treatment of wide-necked aneurysms remains a therapeutic challenge. We conducted this study to evaluate the angiographic results and clinical outcome of patients treated with stent-assisted coiling by using a recently available self-expandable intracranial stent. METHODS: A retrospective review of all patients treated with self-expandable stent-assisted coiling between September 2002 and December 2003 was done. Treatment was attempted in 32 patients with 35 aneurysms. Four of the aneurysms were ruptured. All had either a dome-to-neck ratio less than 2 and/or a neck diameter of 5 mm or larger. Following stent placement, coiling was attempted in 33 of 34 aneurysms. The technical success of the procedure, procedure related complications, and the angiographic results were documented. RESULTS: In 34 of 35 aneurysms, stent deployment across the neck of the aneurysm was successful. Coiling was performed successfully in 30 of 33 aneurysms. In 20 aneurysms, immediate posttreatment angiography showed either total (17%) or satisfactory (50%) occlusion. Procedure-related mortality occurred in one patient (3.1%). Adverse events occurred in eight patients (25%); in three of them permanent neurologic deficit resulted (9.3%). In six patients, thrombus formation occurred within the stented segments during the procedure and reopro infusion was used. Follow-up angiography was available in 12 (40%) of 30 treated aneurysms. CONCLUSION: In our practice use of the self-expandable stent seemed to facilitate endovascular treatment of wide-necked intracranial aneurysms. Difficulty of deployment and stent thrombogenicity are the main drawbacks of the system.     

MR safety and imaging of neuroform stents at 3T

The Neuroform stent is a self-expanding nitinol stent designed for use in wide-necked intracranial aneurysms. Heating and imaging artifacts were evaluated by using a porcine carotid artery aneurysm model in a 3T MR system. A suspended Neuroform stent was tested for deflection. No heating was measured, and no evidence of deflection of the stent was found. Imaging artifacts were minimal. MR imaging in patients with Neuroform stent-treated aneurysms is safe and feasible.