Journal of Korean Neurosurgical Society

  • 제64권1호
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  • Pages.23-29
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  • 2021
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Outcomes of Stent-Assisted Coiling Using the Neuroform Atlas Stent in Unruptured Wide-Necked Intracranial Aneurysms

  • Kwon, Ohyuk (Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Chung, Joonho (Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine)
  • 투고 : 2020.02.27
  • 심사 : 2020.03.30
  • 발행 : 2021.01.01
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초록

Objective : Although stent-assisted coiling (SAC) has been reported to be safe and effective in treating wide-necked aneurysms, the technique has procedure-related complications. Thus, we reported our experiences of SAC using the Neuroform Atlas stent in treating wide-necked aneurysms and evaluated the incidence of and risk factors for procedure-related complications. Methods : From March 2018 to August 2019, we treated 130 unruptured wide-necked aneurysms in 123 patients with Neuroform Atlas stents. Angiographic results and clinical outcomes were reviewed retrospectively. Clinical and angiographic follow-up were performed in all cases (mean, 12.4 months) after the procedure. Results : There were eight cases (6.2%) of procedure-related complications (two dissections, five thromboembolisms, and one hemorrhage) and two (1.5%) of delayed complications (one ischemia and one hemorrhage). There was one case (0.8%) of failure of stent deployment and one (0.8%) of suboptimal positioning of the stent. Follow-up angiography showed complete obliteration in 103 (79.2%), residual neck in 16 (12.3%), and residual aneurysm in 11 cases (8.5%). Aneurysm locations in the middle cerebral artery (odds ratio [OR], 2.211; p=0.046) and the anterior communicating artery (OR, 2.850; p=0.039) were associated with procedure-related complications on univariate analysis. However, no independent risk factor for procedure-related complications was noted in multivariate analysis. Conclusion : The Neuroform Atlas showed a high rate of technical success. Good clinical and radiographic outcomes in early follow-up suggests that the device is feasible and safe. SAC of aneurysms on the middle cerebral artery or anterior communicating artery may require more attention to prevent possible procedure-related complications.

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참고문헌

  1. Caragliano AA, Papa R, Pitrone A, Limbucci N, Nappini S, Ruggiero M, et al. : The low-profile Neuroform Atlas stent in the treatment of wide-necked intracranial aneurysms - immediate and midterm results: an Italian multicenter registry. J Neuroradiol, 2019 [Epub ahead of print]
  2. Cho YD, Sohn CH, Kang HS, Kim JE, Cho WS, Hwang G, et al. : Coil embolization of intracranial saccular aneurysms using the Low-profile Visualized Intraluminal Support (LVISTM) device. Neuroradiology 56 : 543-551, 2014 https://doi.org/10.1007/s00234-014-1363-x
  3. Chung J, Lim YC, Suh SH, Shim YS, Kim YB, Joo JY, et al. : Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period: incidence of and risk factors for periprocedural complications. J Neurosurg 121 : 4-11, 2014 https://doi.org/10.3171/2014.4.JNS131662
  4. Chung J, Suh SH, Hong CK, Joo JY, Lim YC, Shin YS, et al. : Preliminary experience with self-expanding closed-cell stent placement in small arteries less than 2 mm in diameter for the treatment of intracranial aneurysms. J Neurosurg 122 : 1503-1510, 2015 https://doi.org/10.3171/2014.11.JNS14435
  5. Iosif C, Piotin M, Saleme S, Barreau X, Sedat J, Chau Y, et al. : Safety and effectiveness of the Low Profile Visualized Intraluminal Support (LVIS and LVIS Jr) devices in the endovascular treatment of intracranial aneurysms: results of the TRAIL multicenter observational study. J Neurointerv Surg 10 : 675-681, 2018 https://doi.org/10.1136/neurintsurg-2017-013375
  6. 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 11 : 801-806, 2019 https://doi.org/10.1136/neurintsurg-2018-014455
  7. Kim CH, Kim YH, Sung SK, Son DW, Song GS, Lee SW : Clinical safety and effectiveness of stent-assisted coil embolization with Neuroform Atlas stent in intracranial aneurysm. J Korean Neurosurg Soc 63 : 80- 88, 2020 https://doi.org/10.3340/jkns.2019.0154
  8. Kuhn AL, Hou SY, Puri AS, Silva CF, Gounis MJ, Wakhloo AK : Stentassisted coil embolization of aneurysms with small parent vessels: safety and efficacy analysis. J Neurointerv Surg 8 : 581-585, 2016 https://doi.org/10.1136/neurintsurg-2015-011774
  9. Park KY, Jang CK, Lee JW, Kim DJ, Kim BM, Chung J : Preliminary experience of stent-assisted coiling of wide-necked intracranial aneurysms with a single microcatheter. BMC Neurol 19 : 245, 2019 https://doi.org/10.1186/s12883-019-1470-8
  10. Santillan A, Schwarz J, Boddu S, Gobin YP, Knopman J, Patsalides A : Stent-assisted coil embolization of anterior communicating artery aneurysms using the LVIS Jr stent. Interv Neuroradiol 25 : 12-20, 2019
  11. Shankar JJS, Quateen A, Weill A, Tampieri D, Del Pilar Cortes M, Fahed R, et al. : Canadian registry of LVIS Jr for treatment of intracranial aneurysms (CaRLA). J Neurointerv Surg 9 : 849-853, 2017 https://doi.org/10.1136/neurintsurg-2016-012611
  12. Shim YS, Park SK, Chung J : Preliminary experience of stent salvage using Neuroform Atlas stent for procedure-related complication during coil embolization of intracranial aneurysms. Clin Neurol Neurosurg 190 : 105654, 2020 https://doi.org/10.1016/j.clineuro.2019.105654
  13. Ten Brinck MFM, de Vries J, Bartels RHMA, Grotenhuis JA, Boogaarts HD : Neuroform Atlas stent-assisted coiling: preliminary results. Neurosurgery 84 : 179-189, 2019 https://doi.org/10.1093/neuros/nyy048
  14. 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 10 : 1192-1196, 2018 https://doi.org/10.1136/neurintsurg-2017-013516
  15. Yoo DH, Cho YD, Moon J, Lee J, Kang HS, Cho WS, et al. : Long-term outcomes of Low-profile Visualized Intraluminal Support device usage in stent-assisted coiling of intracranial aneurysm. J Clin Neurosci 50 : 287-291, 2018 https://doi.org/10.1016/j.jocn.2018.01.075
  16. Yun JH, Cho CS : Experiences of Neuroform stent applications for ruptured anterior communicating artery aneurysms with small parent vessel. J Korean Neurosurg Soc 48 : 53-58, 2010 https://doi.org/10.3340/jkns.2010.48.1.53
  17. Zhang J, Lv X, Jiang C, Li Y, Yang X, Wu Z : Endovascular treatment of cerebral aneurysms with the use of stents in small cerebral vessels. Neurol Res 32 : 119-122, 2010 https://doi.org/10.1179/174313209X459110