Cay Ferdi, Peker Ahmet, Arat Anıl
Department of Radiology, Hacettepe University Medical School, Ankara, Turkey.
Interv Neuroradiol. 2018 Jun;24(3):263-269. doi: 10.1177/1591019917753710. Epub 2018 Jan 19.
Objectives The Neuroform Atlas stent (AS) is the smallest intracranial stent with an open-cell design. This study reports the first clinical experience with AS. Methods All intracranial aneurysms treated by stent-assisted coiling using a single AS in a single institution were retrospectively evaluated. Patient demographics, aneurysm characteristics, angles between the parent artery and stented branch, technical success, and clinical and angiographic follow-up were analyzed. Results Fifty-five consecutive aneurysms treated with AS-assisted coiling were included. Of these, 69.1% were located distal to the circle of Willis. Technical success rate was 100%. The mean diameters of proximal and distal parent arteries were 2.62 mm (range 1.5-4.4) and 1.8 mm (range 0.8-3.5), respectively. Except for a minor stroke in a patient who completely discontinued antiplatelet therapy on postoperative day 4, there were no clinical events with permanent sequelae, and 94.1% of patients had Raymond-Roy score of 1 or 2 aneurysmal occlusion at a mean follow-up duration of 7.9 months. Although the angle between the parent artery and the stented branch increased significantly ( p < 0.001) with time, the angular change at follow-up was only 16.45 ± 11.03 degrees and was inversely correlated both with preoperative angle and the diameter of the distal parent artery ( r = -0.465 and r = -0.433, respectively, p = 0.004 for both). Conclusion AS-assisted coiling was associated with a favorable early clinical outcome and angiographic results in this series. This stent can be used for distally located aneurysms and results in minimal alteration of the arterial anatomy.
目的 Neuroform Atlas支架（AS）是具有开放式细胞设计的最小颅内支架。本研究报告了AS的首次临床经验。方法 回顾性评估在单一机构中使用单个AS进行支架辅助弹簧圈栓塞治疗的所有颅内动脉瘤。分析患者人口统计学、动脉瘤特征、载瘤动脉与支架置入分支之间的夹角、技术成功率以及临床和血管造影随访情况。结果 纳入55例连续接受AS辅助弹簧圈栓塞治疗的动脉瘤。其中，69.1%位于 Willis 环远端。技术成功率为100%。近端和远端载瘤动脉的平均直径分别为2.62 mm（范围1.5 - 4.4）和1.8 mm（范围0.8 - 3.5）。除1例患者在术后第4天完全停用抗血小板治疗后发生轻度卒中外，无永久性后遗症的临床事件发生，平均随访7.9个月时，94.1%的患者Raymond - Roy分级为1或2级动脉瘤闭塞。尽管载瘤动脉与支架置入分支之间的夹角随时间显著增加（p < 0.001），但随访时角度变化仅为16.45±11.03度，且与术前角度和远端载瘤动脉直径均呈负相关（分别为r = -0.465和r = -0.433，两者p均 = 0.004）。结论 在本系列研究中，AS辅助弹簧圈栓塞与良好的早期临床结局和血管造影结果相关。该支架可用于远端动脉瘤，且对动脉解剖结构的改变最小。
