The Neurform3 stent-assisted endovascular coil embolization for the treatment of intracranial wide-necked aneurysms: long-term follow-up results

Objective: To evaluate the long-term efficacy of Neurform3 stent-assisted endovascular coil embolization in treating intracranial wide-necked aneurysms. Methods: During the period of 2007-2011, Neurform3 stent-assisted endovascular coil embolization was carried out in 118 patients with intracranial wide-necked aneurysms. Of the 118 patients, ruptured aneurysm was seen in 86 and unruptured aneurysm was seen in 32. Neurform3 stent-assisted endovascular coil embolization was carried out in 76 patients of ruptured aneurysm within 72 hours after the onset of bleeding. During the follow-up period, both clinical examination and cerebral angiography were employed to evaluate the therapeutic results. Results: The Neurform3 stent was successfully and accurately deployed in 115 cases (97.5%). During the whole procedure, the stent moved slightly in 2 cases, and failure of deployment occurred in 1 case because of the twist and spasm of the internal carotid artery. Pure stent deployment was adopted in 2 cases, and the microcatheter was introduced into the aneurysm by using the stent struts technique in 66 cases. The microcatheter was 'jailed' between the arterial wall and the stent in 49 aneurysms. The angiography performed immediately after the treatment showed that total occlusion of the aneurysm was achieved in 87 cases (74.4%), subtotal occlusion of the aneurysm was obtained in 30 cases (25.6%). During the operation performance, no evident bleeding events due to the rupture of the aneurysms were observed. Postoperative symptomatic occurred in three cases and asymptomatic cerebral infarction was seen in five cases. A follow-up period ranged from 6 to 60 months was made (mean of 26.8 months), and a total of 105 patients were followed up with cerebral angiography which was performed one to five times. The results showed that complete occlusion of the aneurysms was obtained in 99 patients (84.6%), and thrombosis was found in 36.7% (n=11) of patients with subtotal occlusion of the aneurysms. Recurrence of the aneurysms occurred in 9 cases (7.7%), and endovascular coil embolization was carried again in 5 cases. After the treatment, no rebleeding occurred in all patients, and except for three patients no in-stent stenosis was observed. Conclusion: The Neurform3 stent-assisted endovascular coil embolization is a safe and effective treatment for intracranial wide-necked aneurysms, but the multicenter clinical study is needed to further clarify its long-term efficacy. (authors)