Background and purpose: Wide-necked and fusiform aneurysms still remain a therapeutic challenge both surgically and endovascularly. The authors report their clinical experience and 5 year follow-up results using Neuroform stent, as an adjunct in the treatment of wide-necked and fusiform aneurysms.
Methods: One hundred and seven consecutive patients with 110 wide-necked or fusiform intracranial aneurysms were treated with the Neuroform stent-assisted coiling. Both sequential technique and parallel technique were used. In all cases, embolization was completed by packing the aneurysm sac with a variety of commercially available coils. The technical feasibility of the procedure, procedure-related complications, angiographic results, clinical outcome and follow-up angiography were evaluated.
Results: In every case, the Neuroform stent system was delivered and deployed accurately, and occlusion was achieved. Immediate angiography demonstrated complete occlusion in 57.2%, neck remnant in 27.3% and incomplete occlusion in 15.5%. Procedure-related morbidity was 5.6% and procedural-related mortality was 0.9%. Favorable clinical outcome (modified Rankin scale score: 0-2) was observed in 90.7% of the patients (average follow-up time: 47.3 months). No rehemorrhage of treated aneurysm occurred. Angiography follow-up was obtained in 45.8% (49/107 patients; 51/110 aneurysms; average follow-up time: 37.2 months). The overall recanalization rate was 13.7%. Comparison of occlusion class immediately after treatment and at last follow-up showed that 86.3% of the 51 aneurysms had stable or improved class. Eight aneurysms (36.4%) that were not initially completely occluded converted to complete occlusion on follow-up. No delayed coil or stent migration was found. One patient with in-stent stenosis and one with penetrating artery occlusion occurred as delayed complications.
Conclusion: In treating complex intracranial aneurysms, the Neuroform stent-assisted coiling is a secure and effective technique.