Patients and aneurysms characteristics
Our study included 32 patients (22 females; 10 males) with 33 unruptured aneurysms, treated with the Neuroform Atlas stent. The mean age was 59 years old (range from 31 to 78). Eight patients had a recurrence from a previous treatment; four from an urgent endovascular treatment, performed for subarachnoid hemorrhage, and four from previous ordinary treatment (3 simple coilings and 1 surgical clipping).
Aneurysms were located in the anterior circulation in 29 cases (19 anterior communicating artery – AcoA, 6 in the ophthalmic segment of the internal carotid artery – ICA, 3 in the communicating segment of the ICA and 1 in the carotid bifurcation). The remaining 4 cases involved the basilar artery (Table 1).
Technical results
In all the procedures it was feasible to navigate the Neuroform Atlas to the goal vessel and deploy the stent across the aneurysmal neck.
In 23 cases a single stenting technique was used, in 8 cases a Y stent technique, and in 1 case a telescopic technique.
The immediate occlusion rate was RROC 1 in 28 patients (87,5%), RROC 2 in 3 patients (9,5%) and RROC 3 in 1 patient (3%).
The 12 months follow-up showed RROC of 1 in 30 patients (93,7%) and RROC 2 in 2 patients (6%).
Safety outcomes
Intra-procedural complications were observed in 3 out of 32 treatments. In 2 cases, a small intrastent aggregate was immediately solved with a glycoprotein IIb/IIIa receptor antagonist (Reopro). In 1 case there was a small sac perforation with the second coil. These complications had no clinical consequences.
Late complications were 4; one patient had a retroperitoneal hematoma for femoral access, requiring surgery. Two patients had a minor ischemic stroke in the 15 days following the treatment due to poor adherence to antiaggregant therapy. One patient died for a subarachnoid hemorrhage 2 months after the treatment (due to a partial thrombosis of a giant ophthalmic ICA aneurysm).
The Modified Ranking Scale at 3 months was 0 in the 93,8% of the patients (30/32). Results are summarized in Table 2.
Tab. 1: patients and aneurysms characteristics.
|
Sex
|
|
|
Male
|
10
|
|
Female
|
22
|
|
Mean age
|
59 (range from 31 to 78)
|
|
Aneurysm site
|
|
|
ICA – ophthalmic segment
|
6
|
|
ICA – communicating segment
|
3
|
|
ICA terminus
|
1
|
|
AcoA
|
19
|
|
BA
|
4
|
|
AcoA: anterior communicating artery; BA: basilar artery; ICA: internal carotid artery
|
Tab. 2: efficacy and safety outcome
|
Technical success rate
|
100%
|
|
Immediate optimal occlusion rate – RROC 1+2
|
97%
|
|
Intra-procedural complications
|
9,3%
|
|
Late complications
|
9,3%
|
|
Mortality rate (SAH)
|
3,1%
|
|
mRS 0 at 12 months
|
93,7%
|
|
Occlusion rate at 12 months – RROC 1+2
|
96,9%
|
|
RROC: Raymond-Ray occlusion classification
|
