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Object: Until recently, wide-necked aneurysms were not considered amenable to treatment with coil embolization. The recent introduction of intracranial stents has provided a method of preventing coil migration out of wide-necked aneurysms. The Neuroform2 Treo is a modification of the Neuroform stent; the new version has a higher metal/artery ratio. The authors' initial experience with the use of this stent in combination with coil embolization to treat wide-necked intracranial aneurysms is reported and technical considerations are discussed.
Methods: The authors' first 10 consecutive patients with wide-necked intracranial aneurysms were included in this study. Inclusion criteria restricted the group to adult patients with wide-necked intracranial aneurysms (ruptured and unruptured lesions). A wide neck was defined as a dome/neck ratio of less than 2 or a neck that was 4 mm or wider as measured on angiograms. Immediate postprocedure angiography studies were performed to determine successful coil occlusion of the aneurysm as well as patency of the parent vessel. Six-month follow-up angiograms were obtained in all patients.
Ten aneurysms with poor dome/neck ratios ( 2) were studied in 10 patients. In all cases the stent was delivered to the aneurysm site and positioned without difficulty. No branch artery compromise was observed. A technical difficulty occurred in one case, with prolapse of a coil into the parent vessel, which was successfully corrected with no adverse clinical effects. There were no clinical or neurological complications associated with endovascular treatment of aneurysms in this series. One patient required further coil embolization because of findings on the 6-month follow-up cerebral angiogram.
Conclusions: The Neuroform2 Treo navigates similarly to the Neuroform2, with the advantage of increased aneurysm neck coverage. This feature may lower the retreatment rates for wide-necked cerebral aneurysms.
In this article we review our experience using the Neuroform2 Treo stent (Boston Scientific/Target, Fremont, CA). This stent, with its open-cell design, is similar to the Neuroform2 device, but contains a modified geometry that increases the aneurysm neck coverage. Ten patients with wide-necked aneurysms, defined as a neck/dome ratio of less than 2 or a neck wider than 4 mm, were treated.
In all cases the stent was delivered to the aneurysm site and deposited without difficulty. Complete angiographically confirmed occlusion of the aneurysm was obtained, and normal distal flow was noted. No branch artery compromise was observed. A technical difficulty occurred in one case, with a coil partially prolapsing into the parent vessel, which was successfully repaired by superimposing a second Neuroform2 Treo stent over the one previously deposited. The coil was then trapped between the stents.
There were no treatment-related clinical or neurological complications associated with endovascular occlusion of aneurysms in this series. Six-month follow-up angiography revealed no parent vessel compromise. One patient required completion of coil embolization at 6-month follow-up review. The Neuroform2 Treo system seems to have the deliverability of the Neuroform2, with the advantage of increased aneurysm neck coverage. The 6-month follow-up review constituted a test for the durability of the stent and coil construction.
Endovascular treatment of cerebral aneurysms has advanced significantly in recent years. Improvements in products and methods for coil embolization of cerebral aneurysms are providing favorable outcomes, and follow-up studies are revealing comparable results with surgical clip ligation.
Until recently, wide-necked aneurysms were not considered amenable to coil embolization. Placement of expandable stents through the parent vessel as a scaffold across the neck of the aneurysm held promise because it prevented coil migration out of the lesion. Nevertheless, the initial experience with balloon-mounted coronary stents was disappointing because they were usually difficult to navigate through the tortuous intracranial vasculature. The introduction of the first flexible intracranial stent (Neuroform; Boston Scientific/Target) and recent publication of preliminary series detailing the experience of various investigators in treating wide-necked aneurysms are proving this device to be effective in treating pathological entities that were previously not considered amenable to endovascular therapy.
Recently, the new-generation intracranial stent, called the Neuroform2 Treo, was introduced. This stent, with its open-cell design, is similar to the Neuroform, but contains a modified geometry. The rings of the stent are connected with an extra tine, which decreases the area of the open cells by 39%. The preliminary experience with the use of this stent in combination with coil insertion in treating wide-necked intracranial aneurysms is reported and technical considerations are discussed.
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