UMMS Affiliation

Department of Radiology

Publication Date

2019-01-22

Document Type

Article

Disciplines

Cardiovascular Diseases | Nervous System Diseases | Neurology | Radiology | Surgery | Surgical Procedures, Operative

Abstract

BACKGROUND AND OBJECTIVE: Stent-assisted coil embolization is a well-established treatment of intracranial wide-necked aneurysms. The Neuroform Atlas Stent System is a new generation microstent designed to enhance coil support, conformability, deliverability, and improve deployment accuracy. We present the 1-year efficacy and angiographic results of the Humanitarian Device Exemption (HDE) cohort from the Atlas Investigational Device Exemption (IDE) clinical trial.

METHOD: The Atlas IDE trial is a prospective, multicenter, single-arm, open-label study of unruptured wide-necked intracranial aneurysms treated with the Neuroform Atlas stent and approved coils. The primary efficacy endpoint was the rate of 12-month complete aneurysm angiographic occlusion (Raymond class I) without target aneurysm retreatment or significant parent artery stenosis ( > 50%) at the target location. The primary safety endpoint was the rate of major ipsilateral stroke or neurological death within 12 months. Imaging core laboratory and Clinical EventsCommittee adjudicated the primary endpoints.

RESULTS: 30 patients were enrolled at eight US centers, with 27 patients completing the 12-month angiographic follow-up. The mean age was 59.4+/-11.8 years and 24/30 patients (80%) were women. The mean aneurysm size was 5.3+/-1.7 mm and the dome:neck ratio was 1.1+/-0.2. Procedural technical success of Neuroform Atlas Stent deployment was 100%. 27 patients completed 12-month angiographic follow-up and 30 patients completed their 6-month follow-up. When applying the last observation carried forward method, the primary efficacy endpoint was observed in 26/30 patients (86.7%, 95% CI 69.3% to 96.2%) compared with 25/27 patients (92.6%, 95% CI 75.7% to 99.1%) who completed the 12-month angiographic follow-up. The primary safety endpoint of stroke occurred in one patient (3.3%), who made a complete clinical recovery at discharge. There were no neurological deaths.

CONCLUSION: The Neuroform Atlas stent in conjunction with coils demonstrated a high rate of complete aneurysm occlusion at 12-month angiographic follow-up, with an improved safety profile in the HDE cohort.

CLINICAL TRIALGOV REGISTRATION NUMBER: NCT0234058.

Keywords

ATLAS, atlas stent, cerebral aneurysm, neuroform, stent-assisted coiling, wide-neck aneurysm

Rights and Permissions

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

DOI of Published Version

10.1136/neurintsurg-2018-014455

Source

J Neurointerv Surg. 2019 Jan 22. pii: neurintsurg-2018-014455. doi: 10.1136/neurintsurg-2018-014455. [Epub ahead of print] Link to article on publisher's site

Journal/Book/Conference Title

Journal of neurointerventional surgery

Related Resources

Link to Article in PubMed

PubMed ID

30670625

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

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