Additional rescue stenting with Neuroform Atlas stents during stent-assisted coiling of saccular aneurysms
Overlapping stenting is sometimes attempted during endovascular treatment of cerebral aneurysm as a rescue for coil herniation, stent mal-positioning, or in-stent thrombosis. We retrospectively evaluated the efficacy and safety of additional rescue stenting (ARS) in telescoping fashion with Neurofor...
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| Veröffentlicht in: | Clinical neurology and neurosurgery 2023-07, Vol.230, p.107777-107777, Article 107777 |
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| creator | Choo, Yeon Soo Kim, Eun-Joo Sung, Sang-Min Hwangbo, Lee Lee, Tae-Hong Ko, Jun Kyeung |
| description | Overlapping stenting is sometimes attempted during endovascular treatment of cerebral aneurysm as a rescue for coil herniation, stent mal-positioning, or in-stent thrombosis. We retrospectively evaluated the efficacy and safety of additional rescue stenting (ARS) in telescoping fashion with Neuroform Atlas stent (NAS) during stent-assisted coiling of saccular aneurysms.
We collected clinical and radiological data of patients with saccular aneurysms treated with ARS using NASs between March 2018 and December 2021. Y or X-stent-assisted coiling technique was excluded.
Eighteen unruptured and 5 ruptured aneurysms in 23 patients were treated with ARS using NASs. Sizes of aneurysms ranged from 2.0 mm to 10.0 mm (mean: 5.0 mm). Immediate angiographic results were complete occlusion in 11 aneurysms, residual neck in 4 aneurysms, and residual sac in 8 aneurysms. Peri-operative morbidity was 4.3 %. Nineteen of 23 patients underwent follow-up conventional angiography (mean, 9.9 months). Results showed progressive occlusion in 10 (52.6 %) cases and asymptomatic in-stent stenosis in 3 (15.8 %) cases. At the end of the observation period (mean, 17.4 months), all 18 patients without subarachnoid hemorrhage had excellent clinical outcomes (mRS of 0), except one (mRS of 1). Of five patients with subarachnoid hemorrhage, four had a favorable outcome (mRS of 0–1), while the other one was dependent (mRS of 4).
In this report on 23 patients, ARS with NASs for treating saccular aneurysms showed good technical safety with favorable clinical and angiographic outcomes. However, delayed in-stent stenosis was not uncommon. Thus, regular imaging follow-up is required.
•Overlapping stenting is sometimes attempted during aneurysm coiling as a rescue.•23 saccular aneurysms were treated with additional rescue stenting with Neuroform Atlas stents.•Overlapping stenting for dissecting or blood blister-like aneurysms and Y-stent-assisted coiling were excluded.•Peri-operative morbidity was 4.3%, including a thromboembolim.•Angiographic follow-up showed progressive occlusion in 52.6% and asymptomatic in-stent stenosis in 15.8%. |
| doi_str_mv | 10.1016/j.clineuro.2023.107777 |
| format | Article |
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We collected clinical and radiological data of patients with saccular aneurysms treated with ARS using NASs between March 2018 and December 2021. Y or X-stent-assisted coiling technique was excluded.
Eighteen unruptured and 5 ruptured aneurysms in 23 patients were treated with ARS using NASs. Sizes of aneurysms ranged from 2.0 mm to 10.0 mm (mean: 5.0 mm). Immediate angiographic results were complete occlusion in 11 aneurysms, residual neck in 4 aneurysms, and residual sac in 8 aneurysms. Peri-operative morbidity was 4.3 %. Nineteen of 23 patients underwent follow-up conventional angiography (mean, 9.9 months). Results showed progressive occlusion in 10 (52.6 %) cases and asymptomatic in-stent stenosis in 3 (15.8 %) cases. At the end of the observation period (mean, 17.4 months), all 18 patients without subarachnoid hemorrhage had excellent clinical outcomes (mRS of 0), except one (mRS of 1). Of five patients with subarachnoid hemorrhage, four had a favorable outcome (mRS of 0–1), while the other one was dependent (mRS of 4).
In this report on 23 patients, ARS with NASs for treating saccular aneurysms showed good technical safety with favorable clinical and angiographic outcomes. However, delayed in-stent stenosis was not uncommon. Thus, regular imaging follow-up is required.
•Overlapping stenting is sometimes attempted during aneurysm coiling as a rescue.•23 saccular aneurysms were treated with additional rescue stenting with Neuroform Atlas stents.•Overlapping stenting for dissecting or blood blister-like aneurysms and Y-stent-assisted coiling were excluded.•Peri-operative morbidity was 4.3%, including a thromboembolim.•Angiographic follow-up showed progressive occlusion in 52.6% and asymptomatic in-stent stenosis in 15.8%.</description><identifier>ISSN: 0303-8467</identifier><identifier>EISSN: 1872-6968</identifier><identifier>DOI: 10.1016/j.clineuro.2023.107777</identifier><identifier>PMID: 37201253</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Aneurysm ; Aneurysms ; Angiography ; Asymptomatic ; Cardiovascular system ; Carotid arteries ; Cerebral aneurysm ; Cerebral Angiography ; Cerebral blood flow ; Coil ; Drug dosages ; Embolization, Therapeutic - methods ; Endovascular coiling ; Endovascular Procedures ; Humans ; Implants ; Intracranial Aneurysm - diagnostic imaging ; Intracranial Aneurysm - surgery ; Ischemia ; Morbidity ; Neurology ; Patients ; Retrospective Studies ; Saccule ; Stenosis ; Stent ; Stents ; Subarachnoid hemorrhage ; Subarachnoid Hemorrhage - diagnostic imaging ; Subarachnoid Hemorrhage - surgery ; Thromboembolism ; Thrombosis ; Treatment Outcome ; Veins & arteries</subject><ispartof>Clinical neurology and neurosurgery, 2023-07, Vol.230, p.107777-107777, Article 107777</ispartof><rights>2023 Elsevier B.V.</rights><rights>Copyright © 2023 Elsevier B.V. All rights reserved.</rights><rights>2023. Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-54a50bfc8865cba732ad8b8215f759a33c4608cdae626b1d5a882e5361d259c73</citedby><cites>FETCH-LOGICAL-c396t-54a50bfc8865cba732ad8b8215f759a33c4608cdae626b1d5a882e5361d259c73</cites><orcidid>0000-0001-9697-6216</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2822704181?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27928,27929,45999,64389,64391,64393,72473</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37201253$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Choo, Yeon Soo</creatorcontrib><creatorcontrib>Kim, Eun-Joo</creatorcontrib><creatorcontrib>Sung, Sang-Min</creatorcontrib><creatorcontrib>Hwangbo, Lee</creatorcontrib><creatorcontrib>Lee, Tae-Hong</creatorcontrib><creatorcontrib>Ko, Jun Kyeung</creatorcontrib><title>Additional rescue stenting with Neuroform Atlas stents during stent-assisted coiling of saccular aneurysms</title><title>Clinical neurology and neurosurgery</title><addtitle>Clin Neurol Neurosurg</addtitle><description>Overlapping stenting is sometimes attempted during endovascular treatment of cerebral aneurysm as a rescue for coil herniation, stent mal-positioning, or in-stent thrombosis. We retrospectively evaluated the efficacy and safety of additional rescue stenting (ARS) in telescoping fashion with Neuroform Atlas stent (NAS) during stent-assisted coiling of saccular aneurysms.
We collected clinical and radiological data of patients with saccular aneurysms treated with ARS using NASs between March 2018 and December 2021. Y or X-stent-assisted coiling technique was excluded.
Eighteen unruptured and 5 ruptured aneurysms in 23 patients were treated with ARS using NASs. Sizes of aneurysms ranged from 2.0 mm to 10.0 mm (mean: 5.0 mm). Immediate angiographic results were complete occlusion in 11 aneurysms, residual neck in 4 aneurysms, and residual sac in 8 aneurysms. Peri-operative morbidity was 4.3 %. Nineteen of 23 patients underwent follow-up conventional angiography (mean, 9.9 months). Results showed progressive occlusion in 10 (52.6 %) cases and asymptomatic in-stent stenosis in 3 (15.8 %) cases. At the end of the observation period (mean, 17.4 months), all 18 patients without subarachnoid hemorrhage had excellent clinical outcomes (mRS of 0), except one (mRS of 1). Of five patients with subarachnoid hemorrhage, four had a favorable outcome (mRS of 0–1), while the other one was dependent (mRS of 4).
In this report on 23 patients, ARS with NASs for treating saccular aneurysms showed good technical safety with favorable clinical and angiographic outcomes. However, delayed in-stent stenosis was not uncommon. Thus, regular imaging follow-up is required.
•Overlapping stenting is sometimes attempted during aneurysm coiling as a rescue.•23 saccular aneurysms were treated with additional rescue stenting with Neuroform Atlas stents.•Overlapping stenting for dissecting or blood blister-like aneurysms and Y-stent-assisted coiling were excluded.•Peri-operative morbidity was 4.3%, including a thromboembolim.•Angiographic follow-up showed progressive occlusion in 52.6% and asymptomatic in-stent stenosis in 15.8%.</description><subject>Aneurysm</subject><subject>Aneurysms</subject><subject>Angiography</subject><subject>Asymptomatic</subject><subject>Cardiovascular system</subject><subject>Carotid arteries</subject><subject>Cerebral aneurysm</subject><subject>Cerebral Angiography</subject><subject>Cerebral blood flow</subject><subject>Coil</subject><subject>Drug dosages</subject><subject>Embolization, Therapeutic - methods</subject><subject>Endovascular coiling</subject><subject>Endovascular Procedures</subject><subject>Humans</subject><subject>Implants</subject><subject>Intracranial Aneurysm - diagnostic imaging</subject><subject>Intracranial Aneurysm - surgery</subject><subject>Ischemia</subject><subject>Morbidity</subject><subject>Neurology</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Saccule</subject><subject>Stenosis</subject><subject>Stent</subject><subject>Stents</subject><subject>Subarachnoid hemorrhage</subject><subject>Subarachnoid Hemorrhage - diagnostic imaging</subject><subject>Subarachnoid Hemorrhage - surgery</subject><subject>Thromboembolism</subject><subject>Thrombosis</subject><subject>Treatment Outcome</subject><subject>Veins & arteries</subject><issn>0303-8467</issn><issn>1872-6968</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkctO3DAUhq0KVAboKyBL3bDJ4Mv4kl1HqC1ICDawthzbaR0lMfVJiubt6zTQRTd4Y5_j71z0_whdULKlhMqrbuv6OIY5py0jjJekKucD2lCtWCVrqY_QhnDCK72T6gSdAnSEEM6l_ohOuGKEMsE3qNt7H6eYRtvjHMDNAcMUximOP_BLnH7i-2VGm_KA91NvYf0F7Oe8IH-jygLE8vLYpdgv6dRisM7Nvc3YLlseYIBzdNzaHsKn1_sMPX37-nh9U909fL-93t9VjtdyqsTOCtK0TmspXGMVZ9brRjMqWiVqy7nbSaKdt0Ey2VAvrNYsCC6pZ6J2ip-hy7Xvc06_5gCTGSK40PdlkzSDYZpKJYsEdUE__4d2ac5Fi4ViTJEd1bRQcqVcTgA5tOY5x8Hmg6HELG6Yzry5YRY3zOpGKbx4bT83Q_D_yt7kL8CXFQhFj98xZAMuhtEFH3Nwk_EpvjfjDxW6oAk</recordid><startdate>202307</startdate><enddate>202307</enddate><creator>Choo, Yeon Soo</creator><creator>Kim, Eun-Joo</creator><creator>Sung, Sang-Min</creator><creator>Hwangbo, Lee</creator><creator>Lee, Tae-Hong</creator><creator>Ko, Jun Kyeung</creator><general>Elsevier B.V</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9697-6216</orcidid></search><sort><creationdate>202307</creationdate><title>Additional rescue stenting with Neuroform Atlas stents during stent-assisted coiling of saccular aneurysms</title><author>Choo, Yeon Soo ; 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We retrospectively evaluated the efficacy and safety of additional rescue stenting (ARS) in telescoping fashion with Neuroform Atlas stent (NAS) during stent-assisted coiling of saccular aneurysms.
We collected clinical and radiological data of patients with saccular aneurysms treated with ARS using NASs between March 2018 and December 2021. Y or X-stent-assisted coiling technique was excluded.
Eighteen unruptured and 5 ruptured aneurysms in 23 patients were treated with ARS using NASs. Sizes of aneurysms ranged from 2.0 mm to 10.0 mm (mean: 5.0 mm). Immediate angiographic results were complete occlusion in 11 aneurysms, residual neck in 4 aneurysms, and residual sac in 8 aneurysms. Peri-operative morbidity was 4.3 %. Nineteen of 23 patients underwent follow-up conventional angiography (mean, 9.9 months). Results showed progressive occlusion in 10 (52.6 %) cases and asymptomatic in-stent stenosis in 3 (15.8 %) cases. At the end of the observation period (mean, 17.4 months), all 18 patients without subarachnoid hemorrhage had excellent clinical outcomes (mRS of 0), except one (mRS of 1). Of five patients with subarachnoid hemorrhage, four had a favorable outcome (mRS of 0–1), while the other one was dependent (mRS of 4).
In this report on 23 patients, ARS with NASs for treating saccular aneurysms showed good technical safety with favorable clinical and angiographic outcomes. However, delayed in-stent stenosis was not uncommon. Thus, regular imaging follow-up is required.
•Overlapping stenting is sometimes attempted during aneurysm coiling as a rescue.•23 saccular aneurysms were treated with additional rescue stenting with Neuroform Atlas stents.•Overlapping stenting for dissecting or blood blister-like aneurysms and Y-stent-assisted coiling were excluded.•Peri-operative morbidity was 4.3%, including a thromboembolim.•Angiographic follow-up showed progressive occlusion in 52.6% and asymptomatic in-stent stenosis in 15.8%.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>37201253</pmid><doi>10.1016/j.clineuro.2023.107777</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0001-9697-6216</orcidid></addata></record> |
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| subjects | Aneurysm Aneurysms Angiography Asymptomatic Cardiovascular system Carotid arteries Cerebral aneurysm Cerebral Angiography Cerebral blood flow Coil Drug dosages Embolization, Therapeutic - methods Endovascular coiling Endovascular Procedures Humans Implants Intracranial Aneurysm - diagnostic imaging Intracranial Aneurysm - surgery Ischemia Morbidity Neurology Patients Retrospective Studies Saccule Stenosis Stent Stents Subarachnoid hemorrhage Subarachnoid Hemorrhage - diagnostic imaging Subarachnoid Hemorrhage - surgery Thromboembolism Thrombosis Treatment Outcome Veins & arteries |
| title | Additional rescue stenting with Neuroform Atlas stents during stent-assisted coiling of saccular aneurysms |
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