Stent-Assisted Coiling of Intracranial Aneurysms Using a Nitinol-Based Stent (Neuroform Atlas): A Systematic Review and Meta-analysis
Tóm tắt
The aim of this systematic review and meta-analysis was to synthesize the latest evidence on the efficacy and safety of Neuroform Atlas-assisted coiling of intracranial aneurysms. We performed a comprehensive search for articles that assessed the efficacy and safety of Neuroform Atlas-assisted coiling of intracranial aneurysms. The outcome measurement was adequate occlusion, defined as Raymond–Roy Class I (RR1) + Raymond–Roy Class II (RR2) by previous studies. A total of 557 patients (568 aneurysms) from 13 studies were included. The rate of adequate occlusion after the procedure was 88% (83–94%, I2: 72.21%), and the rates of RR1 and RR2 were 68% (60–77%, I2: 81.87%) and 21% (15–27%, I2: 66.10%), respectively. The adequate occlusion rate at 6 months was 90% (81–99%, I2: 58.04%) and 93% (91–96%, I2: 0%) at the end of a mean of 9.03 ± 1.03 months of follow-up. Periprocedural complications occurred in 35 patients [5% (3–8%, I2: 21.28%)]. Subgroup analysis of unruptured aneurysms showed that the rates of adequate occlusion were 85% (78–93%), 90% (79–100%) (6-month follow-up), and 93% (90–96%) (at the end of follow-up). For the wide-necked aneurysm subgroup, the rate of adequate occlusion was 86% (80–93%) and was 93% (89–97%) at the end of follow-up. Meta-regression showed that initial adequate occlusion was influenced by mean aneurysm neck size (p = 0.034). Neuroform Atlas-assisted coiling is associated with an initial adequate occlusion rate of 88% and a periprocedural complication rate of 6%. The rate of initial adequate occlusion was 85% in unruptured aneurysms and 86% in wide-necked aneurysms. Level 2, Systematic review of non-randomized and single-arm studies.
Tài liệu tham khảo
Pouratian N. Endovascular management of unruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry. 2006;77(5):572–8. https://doi.org/10.1136/jnnp.2005.078469.
Lindgren A, DI Vergouwen M, van der Schaaf I, et al. Endovascular coiling versus neurosurgical clipping for people with aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2018. https://doi.org/10.1002/14651858.CD003085.pub3.
Hong Y, Wang YJ, Deng Z, Wu Q, Zhang JM. Stent-assisted coiling versus coiling in treatment of intracranial aneurysm: a systematic review and meta-analysis. PLoS ONE. 2014. https://doi.org/10.1371/journal.pone.0082311.
Zhang X, Zuo Q, Tang H, et al. Stent assisted coiling versus non-stent assisted coiling for the management of ruptured intracranial aneurysms: a meta-analysis and systematic review. J Neurointerv Surg. 2019;11(5):489–96. https://doi.org/10.1136/neurintsurg-2018-014388.
Cay F, Peker A, Arat A. Stent-assisted coiling of cerebral aneurysms with the Neuroform Atlas stent. Interv Neuroradiol. 2018;24(3):263–9. https://doi.org/10.1177/1591019917753710.
Ishihara H, Ishihara S, Niimi J, et al. Risk factors for coil protrusion into the parent artery and associated thrombo-embolic events following unruptured cerebral aneurysm embolization. Interv Neuroradiol. 2015;21(2):178–83. https://doi.org/10.1177/1591019915582375.
Shanno GB, Armonda RA, Benitez RP, Rosenwasser RH. Assessment of acutely unsuccessful attempts at detachable coiling in intracranial aneurysms. Neurosurgery. 2001;48(5):1066–74. https://doi.org/10.1097/00006123-200105000-00019.
Standhardt H, Boecher-Schwarz H, Gruber A, Benesch T, Knosp E, Bavinzski G. Endovascular treatment of unruptured intracranial aneurysms with guglielmi detachable coils. Stroke. 2008;39(3):899–904. https://doi.org/10.1161/STROKEAHA.107.496372.
Ten Brinck MFM, De Vries J, Bartels RHMA, Grotenhuis JA, Boogaarts HD. Neuro form atlas stent-assisted coiling: preliminary results. Clin Neurosurg. 2019;84(1):179–89. https://doi.org/10.1093/neuros/nyy048.
Administration USF and D. Summary of safety and effectiveness data; 2019. https://www.fda.gov/medical-devices/recently-approved-devices/neuroform-atlasr-stent-system-p180031.
Ulfert C, Pham M, Sonnberger M, et al. The Neuroform Atlas stent to assist coil embolization of intracranial aneurysms: a multicentre experience. J Neurointerv Surg. 2018;10(12):1192–6. https://doi.org/10.1136/neurintsurg-2017-013516.
Ciccio G, Robert T, Smajda S, et al. Double stent assisted coiling of intracranial bifurcation aneurysms in Y and X configurations with the Neuroform Atlas stent: immediate and mid term angiographic and clinical follow-up. J Neurointerv Surg. 2019;11(12):1239–42. https://doi.org/10.1136/neurintsurg-2019-015175.
Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke. 2001;32(9):1998–2004. https://doi.org/10.1161/hs0901.095600.
Baek JW, Jin SC, Kim JH, et al. Initial multicentre experience using the neuroform atlas stent for the treatment of un-ruptured saccular cerebral aneurysms. Br J Neurosurg. 2019. https://doi.org/10.1080/02688697.2019.1680796.
Caragliano AA, Papa R, Pitrone A, et al. The low-profile Neuroform Atlas stent in the treatment of wide-necked intracranial aneurysms—immediate and midterm results: an Italian multicenter registry. J Neuroradiol. 2019. https://doi.org/10.1016/j.neurad.2019.03.005.
Aydin K, Balci S, Sencer S, Barburoglu M, Umutlu MR, Arat A. Y-stent-assisted coiling with low-profile Neuroform Atlas stents for endovascular treatment of wide-necked complex intracranial bifurcation aneurysms. Neurosurgery. 2019. https://doi.org/10.1093/neuros/nyz516.
Goertz L, Dorn F, Siebert E, et al. Safety and efficacy of the Neuroform Atlas for stent-assisted coiling of intracranial aneurysms: a multicenter experience. J Clin Neurosci. 2019;68:86–91. https://doi.org/10.1016/j.jocn.2019.07.030.
Jankowitz BT, Hanel R, Jadhav AP, et al. Neuroform Atlas stent system for the treatment of intracranial aneurysm: primary results of the atlas humanitarian device exemption cohort. J Neurointerv Surg. 2019;11(8):801–6. https://doi.org/10.1136/neurintsurg-2018-014455.
Kim CH, Kim YH, Sung SK, Son DW, Song GS, Lee SW. Clinical safety and effectiveness of stent-assisted coil embolization with neuroform atlas stent in intracranial aneurysm. J Korean Neurosurg Soc. 2019;63(1):80.
Park KY, Jang CK, Lee JW, Kim DJ, Kim BM, Chung J. Preliminary experience of stent-assisted coiling of wide-necked intracranial aneurysms with a single microcatheter. BMC Neurol. 2019;19(1):1–9. https://doi.org/10.1186/s12883-019-1470-8.
Quintana EM, Valdes PV, Deza EM, et al. Initial experience and one-year follow-up with Neuroform Atlas stent system for the treatment of brain aneurysms. Interv Neuroradiol. 2019. https://doi.org/10.1177/1591019918819087.
Tsai JP, Hardman J, Moore NZ, et al. Early post-humanitarian device exemption experience with the Neuroform Atlas stent. J Neurointerv Surg. 2019;11(11):1141–4. https://doi.org/10.1136/neurintsurg-2019-014874.
Johnston SC, Higashida RT, Barrow DL, et al. Recommendations for the endovascular treatment of intracranial aneurysms. Stroke. 2002;33(10):2536–44. https://doi.org/10.1161/01.STR.0000034708.66191.7D.
Kim J-W, Park Y-S. Endovascular treatment of wide-necked intracranial aneurysms: techniques and outcomes in 15 patients. J Korean Neurosurg Soc. 2011;49(2):97. https://doi.org/10.3340/jkns.2011.49.2.97.
Hendricks BK, Yoon JS, Yaeger K, et al. Wide-neck aneurysms: systematic review of the neurosurgical literature with a focus on definition and clinical implications. J Neurosurg. 2019. https://doi.org/10.3171/2019.3.jns183160.
Chalouhi N, Jabbour P, Singhal S, et al. Stent-assisted coiling of intracranial aneurysms. Stroke. 2013;44(5):1348–53. https://doi.org/10.1161/STROKEAHA.111.000641.
King B, Vaziri S, Singla A, Fargen KM, Mocco J. Clinical and angiographic outcomes after stent-assisted coiling of cerebral aneurysms with enterprise and Neuroform stents: a comparative analysis of the literature. J Neurointerv Surg. 2015;7(12):905–9. https://doi.org/10.1136/neurintsurg-2014-011457.
Kato N, Yuki I, Ishibashi T, et al. Visualization of stent apposition after stent-assisted coiling of intracranial aneurysms using high resolution 3D fusion images acquired by C-arm CT. J Neurointerv Surg. 2019. https://doi.org/10.1136/neurintsurg-2019-014966.
Yang H, Sun Y, Jiang Y, et al. Comparison of stent-Assisted coiling vs coiling alone in 563 intracranial aneurysms: safety and efficacy at a high-volume center. Neurosurgery. 2015;77(2):241–7. https://doi.org/10.1227/NEU.0000000000000765.
Zhao B, Tan X, Yang H, et al. Stent-assisted coiling versus coiling alone of poor-grade ruptured intracranial aneurysms: a multicenter study. J Neurointerv Surg. 2017;9(2):165–8. https://doi.org/10.1136/neurintsurg-2016-012259.
Chalouhi N, Starke RM, Koltz MT, et al. Stent-assisted coiling versus balloon remodeling of wide-neck aneurysms: comparison of angiographic outcomes. Am J Neuroradiol. 2013;34(10):1987–92. https://doi.org/10.3174/ajnr.A3538.
Consoli A, Vignoli C, Renieri L, et al. Assisted coiling of saccular wide-necked unruptured intracranial aneurysms: stent versus balloon. J Neurointerv Surg. 2016;8(1):52–7. https://doi.org/10.1136/neurintsurg-2014-011466.
Cai K, Zhang Y, Shen L, Ni Y, Ji Q. Comparison of stent-assisted coiling and balloon-assisted coiling in the treatment of ruptured wide-necked intracranial aneurysms in the acute period. World Neurosurg. 2016;96:316–21. https://doi.org/10.1016/j.wneu.2016.09.029.
Samaniego EA, Mendez AA, Nguyen TN, et al. LVIS Jr device for Y-stent-assisted coil embolization of wide-neck intracranial aneurysms: a multicenter experience. Interv Neurol. 2018;7(5):271–83. https://doi.org/10.1159/000487545.
Cagnazzo F, Ahmed R, Dargazanli C, et al. Treatment of wide-neck intracranial aneurysms with the woven endobridge device associated with stenting: a single-center experience. Am J Neuroradiol. 2019;40(5):820–6. https://doi.org/10.3174/ajnr.A6032.
Arthur AS, Molyneux A, Coon AL, et al. The safety and effectiveness of the woven endobridge (web) system for the treatment of wide-necked bifurcation aneurysms: final 12-month results of the pivotal web intrasaccular therapy (web-it) study. J Neurointerv Surg. 2019;11(9):924–30. https://doi.org/10.1136/neurintsurg-2019-014815.
Aydin K, Stracke CP, Barburoglu M, et al. Long-term outcomes of wide-necked intracranial bifurcation aneurysms treated with T-stent-assisted coiling. J Neurosurg. 2019. https://doi.org/10.3171/2019.9.jns191733.