Safety and Efficacy of the Neuroform Atlas Stent for Treatment of Intracranial Aneurysms
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ORIGINAL ARTICLE
Safety and Efficacy of the Neuroform Atlas Stent for Treatment of Intracranial Aneurysms A Systematic Review and Meta-Analysis Jeremy Lynch1
· Sara Sciacca2 · Juveria Siddiqui2 · Lakshmi Kanagarajah1 · Shahram Derakhshani1
Received: 11 August 2020 / Accepted: 4 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective The Neuroform Atlas (Stryker Neurovascular, Fremont, CA, USA) is a low-profile laser cut self-expanding nitinol stent designed to provide coil support and wall apposition during aneurysm embolisation. In this study, we performed a meta-analysis of outcomes after treatment with the Neuroform Atlas stent for the purpose of coil embolisation. Methods The primary objectives of this meta-analysis were to define the safety (treatment-related complications, neurologic outcomes, mortality rate) and the efficacy (aneurysm occlusion rate) of the treatment of intracranial aneurysms with the Neuroform Atlas stent. A systematic review and meta-analysis was performed by searching PubMed, EMBASE, and the Cochrane CENTRAL Library for all published studies on the treatment of intracranial aneurysms with the Neuroform Atlas device up to 6 April 2020. The review was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results A total of 14 studies were analysed (577 patients with 593 intracranial aneurysms). The mean age was 58.2 years and 35.6% were male. Technical success of the procedure was 100%. RROC1/RROC2 (Raymond-Roy occlusion classification (RROC) 1/2) (total occlusion/neck remnant) at a mean follow-up of 8.9 months was achieved in 94.8%. RROC3 was 4.9%. All-cause mortality was 1.8% and permanent residual neurological deficit or disability was 2.7%. Overall complications at follow-up were 6.2%. Conclusion Our analysis demonstrated good rates of occlusion at follow-up for aneurysms treated with the Atlas device at follow-up. The safety profile appears similar to other low-profile intracranial stents.
Keywords Stroke · Coil · Haemorrhage
Introduction
Availability of Data and Material All collected data are included in the manuscript and accompanying tables. Jeremy Lynch
jeremy.lynch@gmail.com 1
Neurointerventional Radiology, Essex Center for Neurological Sciences, Queen’s University Hospital, Romford, Greater London, RM7 0AG, UK
2
Neuroradiology, King’s College Hospital, Denmark Hill, London, SE5 9RS, UK
Stents create a mechanical scaffold across aneurysmal necks that prevents coil protrusion into the parent vessel, a particular problem in the coil embolisation of bifurcation or wide-necked aneurysms [1]. In the absence of commercially available intracranial stents, coronary stents were initially used for this purpose. The first dedicated self-expanding intracranial stent, the Neuroform (Stryker Neurovascular, Fremont, CA, USA), was released in 2004 [2, 3]. There is evidence that stent-assisted coiling can achieve higher aneurysm occlusion rates compared to other endovascular techniq
