Neuroform stent assisted aneurysm treatment: evolving treatment strategies, complications and results of long term follow-up

Introduction This report details experience with the Neuroform stent, with an emphasis on evolving treatment strategies, complication rates and treatment durability. Methods All patients undergoing Neuroform stent assisted aneurysm treatment were registered in prospectively maintained endovascular databases at two institutions. Results 284 patients with 302 aneurysms underwent aneurysm treatment with Neuroform during a 42-month study period. Imaging follow-up was available for 166 of 286 saccular aneurysms which were treated with stents and coils (average interval 12.9 months). 80 demonstrated progressive thrombosis (48.2%), 40 were unchanged (24.1%) and 46 (27.7%) demonstrated re-canalization, 25 (15.1%) of which were major recanalizations requiring retreatment. The vast majority of recanalizations and retreatments were observed in large or giant aneurysms. A cumulative total of 25 ischemic strokes (8.8%) and eight neurovascular deaths (2.8%) were recorded in these patients. Ten of these strokes were associated with transient deficits which went on to complete resolution by the time of discharge or at the initial clinical follow-up, yielding a significant stroke rate of 5.3%. Delayed (>48 h) complications, including four deaths-related to stroke (n = 2, 6 days and 8 weeks post-procedure) and spontaneous parenchymal hemorrhages (n = 2)-represent events which are a direct consequence of stenting and likely would not have been encountered in the context of standard non-stent supported embolization techniques. Conclusion Neuroform facilitates the endovascular treatment of complex and wide necked cerebral aneurysms. However, complete occlusion at angiographic follow-up remains uncommon and is observed in only one-third of patients. Delayed complications (>48 h) represent an important component of the overall complications associated with Neuroform assisted aneurysm embolization.