Outcomes of Neuroform Atlas Stent System in treating intracranial wide neck aneurysms a single center study

Purpose: In order to manage intracranial wide neck aneurysms,theuseofstent-supportedcoilembolizationhasproven its efficacy worldwide. The Neuroform Atlas Stent System provides enhanced coil support, non-complex deliverability, conforms to the vessel wall, thereby enhancing its efficacy. The purpose of this work was to investigate whether intracranial wide neck aneurysm size and location contributes to the degree of occlusion,evaluated using Raymond-Roy occlusion scale (RROC) on follow-up examinations. We present our single center procedural, 6 month and 24 month follow-up efficacy and angiographic results. Materials and methods: From January 2016 to December 2023 in Pauls Stradins Clinical University Hospital, 166 intracranial ruptured or unruptured wide neck aneurysms were treated with Atlas stent-assisted coiling system under general anesthesia with jailing or with sequential embolization techniques. The study’s primary efficacy endpoint was the rate of 6-month complete aneurysm angiographic occlusion, which was evaluated using RROC (RR I). Main variables that were recorded: aneurysm size, location and the records of previous subarachnoid hemorrhage, follow-up imaging. Patients with multiple aneurysms were recorded as separate. Results: 122 (73%) patients were female, and the mean age of patients was 56.93 (+/-12.9 years). The mean diameter of the aneurysm sac and neck was 5.2 (+/-2.3mm), 3.8 (+/-1.2mm) respectively. Average aneurysm sack/neck ratio was 1.3 (+/-0.43). 56 (33.7%) aneurysms were localized in the ophthalmic segment of ACI. 110 (66.7%) aneurysms were treated with the jailing technique. Due to anatomical complexity, in 2 instances, a different stent-system was used. Out of 166 treated aneurysms 22 (13.3%) had previously ruptured. In total 7 (4.2%) complications during the procedure were recorded,
of which 3 (1.8%) were aneurysm ruptures. Average follow-up time was 14.42 months. There were no records of rupture during follow-up examinations. 79 (59%) aneurysms were classed as RR I after procedures, after 6 months 84 (73%) classed as RR I, and at 24 months 32 (80) classed as RR I. No statistically significant results were found regarding the applied embolization technique, aneurysm size and its anatomical location in regards to RROC at any evaluated timeframe. 8 (38%) aneurysms of 22 which had previous rupture, had a RR score above I, but this did not contribute to any statistically significant difference due to low count of incidences. Conclusion: In summary, our study highlights the efficacy and safety of the Neuroform Atlas Stent System for treating intracranial wide-neck aneurysms. Given these promising results, future research should focus on evaluating the long-term outcomes of treating ruptured aneurysms to further refine treatment strategies.