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Title: [Clinical application of Neuroform Atlas stent-assisted coiling in the treatment of unruptured wide-neck intracranial aneurysms].
Author: Han JT, Zhang YX, Jia ZC, Jiang CH, Liu L, Luan JY, Liang F, Zhao YQ.
Journal: Beijing Da Xue Xue Bao Yi Xue Ban; 2023 Feb 18; 55(1):139-143. PubMed ID: 36718702.
Abstract:
OBJECTIVE: To assess the safety and efficacy of Neuroform Atlas stent used in treatment of unruptured wide-neck intracranial aneurysms. METHODS: Clinical data of 62 patients with unruptured wide-neck intracranial aneurysms undergoing Neuroform Atlas stent-assisted coiling from August 2020 to September 2021 were retrospectively analyzed. There were 64 aneurysms in those 62 patients. Among them, 25 aneurysms were located at the bifurcation of M1 segment on middle cerebral artery, 16 at the anterior communicating artery, 10 at the C7 segment of internal carotid artery, 5 at the C6 segment of internal carotid artery, 4 at the apex of basilar artery, 3 at the A3 segment of anterior cerebral artery, and 1 at the M2 segment of middle cerebral artery. All the patients underwent Neuroform Atlas stent-assisted coiling, including 49 patients with single stent assisted coiling and 15 patients with dual stents assisted coiling (14"Y"style and 1"X"style). After the procedure, the immediate DSA was performed to evaluate the status of aneurysm occlusion and the parent artery patency. The clinical follow-up was performed 3 months after the operation and evaluated based on the modified Rankin Scale(mRS).DSA image was reviewed at 6 months after operation and Raymond grading scale was used to assess the status of aneurysm occlusion and the parent artery patency. RESULTS: A total of 62 patients with 64 aneurysms were all achieved technical success(100%).The immediate post-procedural Raymond scale was assessed, including Raymond Ⅰ in 57 aneurysms(89.1%, 57/64), Raymond Ⅱ in 6 aneurysms(9.3%, 6/64) and Raymond Ⅲ in 1 aneurysm(1.6%, 1/64). The peri-procedural complications rate was 4.8%(3/62), 2 patients developed intraoperative thrombosis and 1 patient suffered from local subarachnoid hemorrhage. Among them, 55 patients obtained 3 months clinical follow-up after operation and all the patients had good outcomes (mRS≤2), 50 patients with 52 aneurysms were followed up with DSA 6 months after operation, including Raymond Ⅰ in 45 aneurysms(86.5%, 45/52), Raymond Ⅱ in 4 aneurysms(7.7%, 4/52) and Raymond Ⅲ in 3 aneurysms(5.8%, 3/52). CONCLUSION: Neuroform Atlas stent for the treatment of unruptured wide-neck intracranial aneurysms has high safety and good efficacy, and has its advantages over other traditional stents. 目的: 探讨Neuroform Atlas支架辅助弹簧圈栓塞治疗未破裂性颅内宽颈动脉瘤的安全性和有效性。方法: 回顾性分析2020年8月至2021年9月于北京大学第三医院介入血管外科采用Neuroform Atlas支架辅助弹簧圈栓塞治疗的62例未破裂性颅内宽颈动脉瘤患者的临床资料。62例患者共64个颅内动脉瘤，其中25个位于大脑中动脉M1分叉处，16个位于前交通动脉，10个位于颈内动脉C7段，5个位于颈内动脉C6段，4个位于基底动脉顶端，3个位于大脑前动脉A3段，1个位于大脑中动脉M2段。有49个动脉瘤采取单支架辅助栓塞，其余15个采用双支架技术辅助栓塞(“Y”型14个和“X”型1个)。所有患者术后即刻行数字减影血管造影(digital subtraction angiography，DSA)，评估动脉瘤的即刻栓塞效果(Raymond评分)和载瘤动脉血流情况。出院后对患者进行临床随访及影像学随访，临床随访为术后3个月采用改良Rankin评分量表(modified Rankin Scale，mRS)评估患者的临床预后; 影像学随访为术后6个月复查脑血管DSA评估患者动脉瘤闭塞情况(Raymond评分)和载瘤动脉通畅情况。结果: 62例患者手术均获成功，技术成功率为100%。术后即刻DSA显示：57个动脉瘤(89.1%，57/64)完全闭塞(Raymond Ⅰ级)，6个动脉瘤(9.3%，6/64)瘤颈残留(Raymond Ⅱ级)，1个动脉瘤(1.6%，1/64)瘤体残留(Raymond Ⅲ级)。3例患者(4.8%，3/62)出现围手术期并发症：2例为术中血栓形成，予动脉内替罗非班治疗后血流恢复，1例为术后局限性蛛网膜下腔出血，经保守治疗出院时均无致残性功能障碍。术后3个月时55例患者获临床随访，均预后良好(mRS≤2分)，7例患者失访。50例患者(52个动脉瘤)获术后6个月DSA影像随访：Raymond Ⅰ级45个(86.5%，45/52)，Raymond Ⅱ级4个(7.7%，4/52)，Raymond Ⅲ级3个(5.8%，3/52)，12例患者失访。结论: Neuroform Atlas支架辅助弹簧圈栓塞未破裂性颅内宽颈动脉瘤有很高的技术成功率，并具有较低的围手术期并发症发生率和较高的动脉瘤闭塞率，安全性和有效性均较好，但其远期疗效还需进一步随访观察。

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