460 | VOLUME 61 | NUMBER 3 | SEPTEMBER 2007www.neurosurgery-online.comCLINICAL STUDIESNEUROFORMSTENT-ASSISTEDCOILEMBOLIZATIONOFWIDE-NECKINTRACRANIALANEURYSMS:STRATEGIES INSTENTDEPLOYMENTANDMIDTERMFOLLOW-UPOBJECTIVE: To evaluate the midterm results of intracranial stent-assisted coil emboliza-tion in the treatment of wide-necked cerebral aneurysms and to assess the efficacy ofvarious strategies used in stent deployment.METHODS: A retrospective study of 42 patients with 46 wide-necked cerebral aneurysmsenrolled in a prospective single-center registry of patients treated with a Neuroformstent (Boston Scientific/Target, Fremont, CA), a flexible self-expanding nitinol stent, wasperformed. Twenty-seven of 46 aneurysms were unruptured aneurysms, 14 were recanal-ized aneurysms, and five were acutely ruptured. Thirty-nine aneurysms were located inthe 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 beforestenting 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 33aneurysms 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 46of 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 observedin four (80%) aneurysms and one (20%) neck remnant reduced in size. At angiographicfollow-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 remnantsremained unchanged and one (33%) neck remnant decreased in size. Procedural mor-bidity was observed in two of 42 patients (4.8%) and one patient died. On clinicalfollow-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 embolizationis 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 aneurysmocclusion and tolerance to the stent.KEY WORDS: Aneurysm, Coils, Endovascular, Intracranial, Neuroform, StentNeurosurgery 61:460–469, 2007DOI: 10.1227/01.NEU.0000280048.93275.75 www.neurosurgery-online.comAlessandra Biondi, M.D.Division of Interventional Neuroradiology,New York Presbyterian Hospital–Weill Medical College of Cornell University,New York, New YorkVallabh Janardhan, M.D.Division of Interventional Neuroradiology,New York Presbyterian Hospital–Weill Medical College of Cornell University,New York, New YorkJeffrey M. Katz, M.D.Division of Interventional Neuroradiology,New York Presbyterian Hospital–Weill Medical College of Cornell University,New York, New YorkKimberly Salvaggio, R.N., N.P.Division of Interventional Neuroradiology,New York Presbyterian Hospital–Weill Medical College of Cornell University,New York, New YorkHoward A. Riina, M.D.Division of InterventionalNeuroradiology andDepartment of Neurosurgery,New York Presbyterian Hospital–Weill Medical College of Cornell University,New York, New YorkY. Pierre Gobin, M.D.Division of InterventionalNeuroradiology andDepartments of Radiology,New York Presbyterian Hospital–Weill Medical College of Cornell University,New York, New YorkReprint 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: [email protected], April 27, 2006.Accepted, April 4, 2007.Nontotal occlusion is still a major limita-tion of coil therapy, especially in wide-necked and large aneurysms. Re-canalization is observed despite the use ofcoated platinum coils and the balloon remod-eling technique. The development of intracra-nial stents has increased the options for thetreatment of wide-necked aneurysms (1, 2, 10,NEUROSURGERYVOLUME 61 | NUMBER 3 | SEPTEMBER 2007 | 461NEUROFORMSTENT-ASSISTEDCOILEMBOLIZATION OFIAS15, 19, 27). Stent-assisted coil embolization allows for ade-quate coil placement and prevents coil protrusion into theparent vessel. In addition, intracranial stents might help pre-vent aneurysm recanalization. Different stent techniques areused regarding the timing of stent deployment in relation tocoiling. The purpose of our study was to evaluate the angio-graphic and clinical results and midterm follow-up ofintracranial stent-assisted coil embolization using differentstrategies of stent deployment in the treatment of wide-necked aneurysms.PATIENTS AND METHODSWe performed a review of the clinical and radiological records of allpatients included during a 31-month period from November 2002 toJune 2005 in a prospective single-center registry of patients treatedwith a self-expandable nitinol Neuroform stent (Boston Scientific/Target, Fremont, CA). The study was carried on a consecutive series of42 patients with 46 intracranial aneurysms.There were 35 women and seven men. Mean age was 57 years witha range from 11 to 88 years.Thirty-nine aneurysms were located in the anterior and seven inthe posterior circulation. Aneurysm locations are reported in Table 1.Twenty-six aneurysms were on the left side, 17 on the right, andthree involved the basilar artery. According to the InternationalStudy 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 evalu-ated 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 (ⱕ1.5 mm). Twenty-seven of46 (59%) aneurysms were de novo unruptured aneurysms, 14 (30%)were recanalized (five unruptured and nine ruptured in the past,which had
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