Department of Radiology, Duke University, Durham, North Carolina, USA.
J Neurointerv Surg. 2012 Jul;4(4):287-90. doi: 10.1136/neurintsurg-2011-010008. Epub 2011 Jun 28.
Intracranial stents have expanded endovascular therapy to wide neck aneurysms whose dimensions and configurations are not amendable to coil embolization alone. Stents however have not eliminated all problems due to technical factors with their delivery systems. The Neuroform stent system is one of the most widely used for this purpose and has undergone several technical modifications to improve deliverability. Despite improvements in the delivery system there are still reports of failure of stent deployment with the Neuroform 3. Here a simple back table modification is described in which the stent is pushed several centimeters back into the delivery catheter from its manufactured location. This makes the catheter tip more flexible and in our experience improves navigation through vessel curvature and increases deployment rate.
Our institution's cerebrovascular database was reviewed retrospectively in compliance with institutional review board approval to identify all Neuroform 3 stents used for assistance with aneurysm embolization since the current stent design became clinically available. Records were reviewed to identify cases of failure of stent placement using the above described technical modification.
139 Neuroform 3 stents were placed at our institution for assistance with aneurysm embolization with the technique described above. Only three instances of failure of stent placement related to trackability of the delivery system were identified for a technical failure rate of 2.2%.
A simple back table modification to the Neuroform 3 delivery system is described which in our single center experience may improve trackability and ultimately successful stent deployment.
颅内支架已将血管内治疗扩展到宽颈动脉瘤，这些动脉瘤的尺寸和形状不能仅通过线圈栓塞来改善。然而，支架并不能消除其输送系统的技术因素所带来的所有问题。Neuroform 支架系统是为此目的最广泛使用的系统之一，已经进行了几次技术改进以提高可输送性。尽管输送系统有所改进，但仍有报道称 Neuroform 3 的支架部署失败。这里描述了一种简单的台架修改方法，其中支架从其制造位置被推入输送导管几厘米。这使得导管尖端更灵活，根据我们的经验，它可以改善通过血管曲率的导航，并提高部署速度。
我们机构的脑血管数据库按照机构审查委员会的批准进行了回顾性审查，以确定自当前支架设计在临床上可用以来，所有用于辅助动脉瘤栓塞的 Neuroform 3 支架的使用情况。记录被审查以确定使用上述技术修改的支架放置失败的病例。
在我们机构中，使用上述技术共放置了 139 个 Neuroform 3 支架来辅助动脉瘤栓塞。仅确定了 3 例与输送系统可跟踪性相关的支架放置失败，技术失败率为 2.2%。
描述了一种简单的 Neuroform 3 输送系统的台架修改方法，根据我们的单中心经验，这种方法可能会提高可跟踪性，并最终成功地部署支架。
