Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms

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Object. The authors report their experience with the use of the Neuroform Microdelivery System for intravascular reconstruction. They assess the technical feasibility of the system, the efficacy of the combined application of stent and detachable coils, and the follow-up findings.

Methods. Fifty patients found to harbor a complex wide-necked intracranial aneurysm were selected for the study. Different strategies were chosen and the performance and technical success of the device were evaluated. Stent placement was recorded as optimal or suboptimal with respect to the stent position. Clinical and angiographic follow-up examinations were obtained.

Forty-six patients with 48 intracranial aneurysms were treated, leading to a technical success rate of 92%. Forty-two lesions were located in the anterior circulation. In every case the dome/neck ratio was less than 2 and the mean aneurysm size in these patients was 8.8 mm. The most frequent clinical presentation was subarachnoid hemorrhage in 48% of cases. Stent placement was optimal in 81.2% of cases and suboptimal in 18.8%. In 31% of cases, the investigators encountered difficulties in placing the Neuroform stent. Clinical follow up was recorded in all patients and angiographic follow up was obtained in 63%. There were no cases of repeated hemorrhage. In a single case in which only the stent was implanted progressive thrombosis was identified during the follow-up period. The procedure-related morbidity and mortality rates were 8.6 and 2.1%, respectively.

Conclusions. On the basis of the results, the authors conclude that the Neuroform self-expanding stent is a flexible and useful device that can be readily and safely maneuvered through tortuous intracranial vessels, enabling the endovascular treatment of complex wide-necked aneurysms. Early in the authors' experience, stent delivery presented difficulties; however, a second generation of devices has resolved this limitation. Although the early results are promising, the long-term benefit of this technique has to be proved by angiographic and clinical follow-up examinations.

Article Information

Address reprint requests to: Pedro Lylyk, M.D., Libertador AV. 6647, Buenos Aires, Argentina. email: plylyk@lylyk.com.ar.

© AANS, except where prohibited by US copyright law.

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Figures

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    Angiograms obtained in a 65-year-old woman with a history of SAH. A and B: Two DS angiograms depicting a wide-necked aneurysm of the left posterior communicating artery. C: A 3D angiogram demonstrating the complex anatomy of the lesion. D: Initially, the dome was secured with regular coils. E and F: Endovascular reconstruction with the Neuroform2 stent. G and H: Total aneurysm occlusion with coils across the stent.

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    Angiograms obtained in a 52-year-old man who presented with SAH. A and B: Both DS (A) and 3D (B) angiograms revealing a wide-necked P2 aneurysm on the left side. C: A first-generation Neuroform stent optimally implanted across the neck of the lesion. Note the radiopaque markers. D: The aneurysm is secured with coils. E: Finally, total exclusion of the aneurysm.

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    Angiograms obtained in a 57-year-old man with a history of migraine. A and B: Both DS (A) and 3D (B) angiograms revealing a right middle cerebral artery wide-necked aneurysm that was found incidentally. C: During the procedure, the microwire (GUIA) is placed in the M2 segment, distal to the aneurysm neck. D: The Neuroform2 stent is implanted. E and F: A control DS angiogram demonstrating an optimal stent position. Note the radiopaque markers.

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    Angiograms obtained in a 59-year-old man with a history of third cranial nerve palsy. A: A DS angiogram revealing multiple aneurysms (one paraophthalmic and the other on the ChoA segment). B and C: A first-generation Neuroform stent is placed across the aneurysm neck. D: Coiling phase. E and F: Two DS angiograms demonstrating near-total occlusion and “white spots” secondary to thrombus formation. G: Intraarterial infusion of abciximab. H and I: Postoperative angiogram demonstrating complete disappearance of thrombus.

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