CLINICAL STUDIES Alessandra Biondi M D Division of Interventional Neuroradiology New York Presbyterian Hospital Weill Medical College of Cornell University New York New York NEUROFORM STENT ASSISTED COIL EMBOLIZATION OF WIDE NECK INTRACRANIAL ANEURYSMS STRATEGIES IN STENT DEPLOYMENT AND MIDTERM FOLLOW UP Vallabh Janardhan M D Division of Interventional Neuroradiology New York Presbyterian Hospital Weill Medical College of Cornell University New York New York Jeffrey M Katz M D Division of Interventional Neuroradiology New York Presbyterian Hospital Weill Medical College of Cornell University New York New York Kimberly Salvaggio R N N P Division of Interventional Neuroradiology New York Presbyterian Hospital Weill Medical College of Cornell University New York New York Howard A Riina M D Division of Interventional Neuroradiology and Department of Neurosurgery New York Presbyterian Hospital Weill Medical College of Cornell University New York New York Y Pierre Gobin M D Division of Interventional Neuroradiology and Departments of Radiology New York Presbyterian Hospital Weill Medical College of Cornell University New York New York Reprint requests Alessandra Biondi M D Division of Interventional Neuroradiology New York Presbyterian Hospital Weill Medical College of Cornell University 525 East 68th Street New York NY 10021 Email alessandra biondi psl aphp fr Received April 27 2006 Accepted April 4 2007 OBJECTIVE To evaluate the midterm results of intracranial stent assisted coil embolization in the treatment of wide necked cerebral aneurysms and to assess the efficacy of various strategies used in stent deployment METHODS A retrospective study of 42 patients with 46 wide necked cerebral aneurysms enrolled in a prospective single center registry of patients treated with a Neuroform stent Boston Scientific Target Fremont CA a flexible self expanding nitinol stent was performed Twenty seven of 46 aneurysms were unruptured aneurysms 14 were recanalized aneurysms and five were acutely ruptured Thirty nine aneurysms were located in the anterior and seven in the posterior circulation Mean aneurysm size was 9 8 mm Stenting before coiling was performed in 13 of 45 aneurysms 29 coiling before stenting in 27 of 45 aneurysms 60 and stenting alone in five of 45 aneurysms 11 The balloon remodeling technique for coiling before stenting was performed in 77 of patients Angiographic and clinical follow up was available in 31 patients with 33 aneurysms and ranged from 3 to 24 months RESULTS Neuroform stenting was attempted in 46 wide necked aneurysms 42 patients Forty nine stent sessions were performed including three poststent retreatments In 46 of 49 sessions 94 successful deployment of 47 stents for 45 aneurysms was obtained In 40 aneurysms treated with stent assisted coiling angiographic results showed 14 35 aneurysm occlusions 18 45 neck remnants and eight 20 residual aneurysms In five recanalized aneurysms treated with stenting alone no changes were observed in four 80 aneurysms and one 20 neck remnant reduced in size At angiographic follow up in 30 aneurysms treated with stent assisted coiling there were 17 57 aneurysm occlusions seven 23 neck remnants and six 20 residual aneurysms In three recanalized aneurysms treated with stent alone two 67 neck remnants remained unchanged and one 33 neck remnant decreased in size Procedural morbidity was observed in two of 42 patients 4 8 and one patient died On clinical follow up the modified Rankin Scale score was 0 in 27 patients 87 1 in three patients 10 and 2 3 in one patient No aneurysm bled during the follow up period CONCLUSION These results indicate that Neuroform stent assisted coil embolization is a safe and effective technique in the treatment of wide necked cerebral aneurysms Further studies are needed to evaluate the long term durability of stent assisted aneurysm occlusion and tolerance to the stent KEY WORDS Aneurysm Coils Endovascular Intracranial Neuroform Stent Neurosurgery 61 460 469 2007 N DOI 10 1227 01 NEU 0000280048 93275 75 ontotal occlusion is still a major limitation of coil therapy especially in widenecked and large aneurysms Recanalization is observed despite the use of 460 VOLUME 61 NUMBER 3 SEPTEMBER 2007 www neurosurgery online com coated platinum coils and the balloon remodeling technique The development of intracranial stents has increased the options for the treatment of wide necked aneurysms 1 2 10 www neurosurgery online com NEUROFORM STENT ASSISTED COIL EMBOLIZATION OF IAS 15 19 27 Stent assisted coil embolization allows for adequate coil placement and prevents coil protrusion into the parent vessel In addition intracranial stents might help prevent aneurysm recanalization Different stent techniques are used regarding the timing of stent deployment in relation to coiling The purpose of our study was to evaluate the angiographic and clinical results and midterm follow up of intracranial stent assisted coil embolization using different strategies of stent deployment in the treatment of widenecked aneurysms A B C D PATIENTS AND METHODS We performed a review of the clinical and radiological records of all patients included during a 31 month period from November 2002 to June 2005 in a prospective single center registry of patients treated with a self expandable nitinol Neuroform stent Boston Scientific Target Fremont CA The study was carried on a consecutive series of 42 patients with 46 intracranial aneurysms There were 35 women and seven men Mean age was 57 years with a range from 11 to 88 years Thirty nine aneurysms were located in the anterior and seven in the posterior circulation Aneurysm locations are reported in Table 1 Twenty six aneurysms were on the left side 17 on the right and three involved the basilar artery According to the International Study of Unruptured Intracranial Aneurysms size classification 28 24 aneurysms were small nine medium nine large and four giant two partially thrombosed Recanalized aneurysm size was evaluated on the basis of the circulant portion during the stent session Mean aneurysm size was 9 8 mm All aneurysms had a large 4 mm neck and or dome neck ratio 1 5 mm Twenty seven of 46 59 aneurysms were de novo unruptured aneurysms 14 30 were recanalized five unruptured and nine ruptured in the past which had been previously treated using coils in 12 patients and clips in two and five 11 aneurysms were acutely ruptured Among the 27 unruptured aneurysms 10 were incidental 10 presented with
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