From the Department of Interventional Radiology (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Interventional Institute of Zhengzhou University (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), Zhengzhou, China.
AJNR Am J Neuroradiol. 2024 Jul 8;45(7):899-905. doi: 10.3174/ajnr.A8238.
The Neuroform Atlas stent and the LVIS Jr stent are intracranial microstent systems for the treatment of wide-neck intracranial aneurysms. Hence, this study aimed to compare the efficacy and safety of the Neuroform Atlas stent and the LVIS Jr stent for the treatment of unruptured intracranial aneurysms in parent arteries of <2 mm in diameter.
From March 2022 to April 2023, the clinical and imaging data of 135 patients with unruptured intracranial aneurysms treated with stent-assisted coiling using the Neuroform Atlas or LVIS Jr stent in parent arteries of <2 mm in diameter were retrospectively analyzed. Stent apposition was evaluated by high-resolution conebeam CT (HR-CBCT). Immediate aneurysm-embolization attenuation and occlusion at 6-month follow-up were evaluated using 2D DSA and the modified Raymond-Roy classification. Adverse events were recorded. Multivariate logistic regression analysis was undertaken to determine the independent factors affecting incomplete stent apposition.
One hundred thirty-five patients (135 aneurysms) underwent stent-assisted coiling (66 Neuroform Atlas stents and 69 LVIS Jr stents). Intraoperative HR-CBCT showed that 1 Neuroform Atlas stent and 11 LVIS Jr stents had incomplete stent apposition at the aneurysm neck (< .05). Perioperative complications occurred in 3 cases (2.22%). These comprised 2 cases of neurologic complications (1 case of distal intracranial vascular embolism and 1 case of cerebral parenchymal hemorrhage) and 1 case of severe postprocedural gastrointestinal hemorrhage. DSA follow-up showed 3 cases of aneurysm recurrence in the LVIS Jr group. Multivariate regression analysis showed that a stent angle of ≥75° (OR, 23.963; = .005) or a parent artery diameter mismatch ratio of ≥1.25 (OR, 8.043; = .037) were risk factors for incomplete stent apposition, especially for the LVIS Jr stent (OR, 20.297; = .015).
The Neuroform Atlas stent and LVIS Jr stent are efficacious in the treatment of unruptured intracranial aneurysms in parent arteries of <2 mm in diameter. Apposition of the LVIS Jr stent was worse than in the Neuroform Atlas stent at the neck of some aneurysms.
Neuroform Atlas 支架和 LVIS Jr 支架是用于治疗宽颈颅内动脉瘤的颅内微支架系统。因此，本研究旨在比较 Neuroform Atlas 支架和 LVIS Jr 支架治疗直径<2mm 载瘤动脉未破裂颅内动脉瘤的疗效和安全性。
回顾性分析 2022 年 3 月至 2023 年 4 月期间采用 Neuroform Atlas 或 LVIS Jr 支架辅助弹簧圈栓塞治疗的 135 例直径<2mm 载瘤动脉未破裂颅内动脉瘤患者的临床和影像学资料。采用高分辨率锥形束 CT（HR-CBCT）评估支架贴壁情况。采用二维数字减影血管造影（2D DSA）和改良 Raymond-Roy 分级评估术后 6 个月即刻动脉瘤栓塞程度和闭塞程度。记录不良事件。采用多变量 logistic 回归分析确定影响支架不完全贴壁的独立因素。
135 例患者（135 个动脉瘤）接受支架辅助弹簧圈栓塞治疗（Neuroform Atlas 支架 66 枚，LVIS Jr 支架 69 枚）。术中 HR-CBCT 显示，Neuroform Atlas 支架 1 枚和 LVIS Jr 支架 11 枚在瘤颈处存在支架不完全贴壁（<0.05）。围手术期并发症 3 例（2.22%），包括 2 例神经并发症（1 例远端颅内血管栓塞，1 例脑实质出血）和 1 例严重术后胃肠道出血。DSA 随访显示，LVIS Jr 组 3 例动脉瘤复发。多变量回归分析显示，支架角度≥75°（OR，23.963；=0.005）或载瘤动脉直径不匹配率≥1.25（OR，8.043；=0.037）是支架不完全贴壁的危险因素，尤其是对于 LVIS Jr 支架（OR，20.297；=0.015）。
Neuroform Atlas 支架和 LVIS Jr 支架治疗直径<2mm 载瘤动脉未破裂颅内动脉瘤均有效。在某些动脉瘤的瘤颈处，LVIS Jr 支架的贴壁效果不如 Neuroform Atlas 支架。
