Expanded range of indications for Neuroform Atlas stent in the treatment of very small, wide-necked cerebral aneurysms

Abstract

The purpose of this study was to investigate the range of indications for using the Neuroform Atlas stent. Between 2016 and 2020, we treated 20 females and 5 males for aneurysms with a diameter of less than 3 mm and an aspect ratio less than 1.5. The diameter of the parent arteries varied from 1.1 mm to 4.5 mm. There were 13 ruptured and 12 unruptured aneurysms. Double stent-assisted coiling was performed in 14 cases, and single stent-assisted coiling was performed in 11 cases. After deployment, the morphology of the Neuroform Atlas stents was analyzed in tapered or Y-shaped silicone tubes that simulated parent arteries. Radiological results were assessed 7 months and 2 years after the intervention using the Raymond-Roy scale. Clinical outcome was assessed 1 year after the intervention using the modified Rankin score. There were three fatal outcomes. One aneurysm was recoiled. The rate of class I aneurysm occlusion was registered in 21 patients at the last follow-up. At the end of the clinical follow-up period, a favorable outcome (modified Rankin scale 0 –1) was registered in nine patients with ruptured aneurysms. An analysis of the morphology of the stents deployed in the silicone tubes provided an explanation for the stability of the coil mass in the treated aneurysms. Our results suggest that the range of indications for use of the Neuroform Atlas stent can be expanded beyond the present range with regard to the diameter of the parent vessels and size of the aneurysms.