Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Silent Embolic Infarction after Neuroform Atlas Stent-Assisted Coiling of Unruptured Intracranial Aneurysms

  • Seungho Shin (Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University) ;
  • Lee Hwangbo (Department of Diagnostic Radiology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University) ;
  • Tae-Hong Lee (Department of Diagnostic Radiology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University) ;
  • Jun Kyeung Ko (Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University)
  • Received : 2023.05.09
  • Accepted : 2023.08.19
  • Published : 2024.01.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : There is still controversy regarding whether neck remodeling stent affects the occurrence of silent embolic infarction (SEI) after aneurysm coiling. Thus, the aim of the present study is to investigate the incidence of SEI after stent-assisted coiling (SAC) using Neuroform Atlas Stent (NAS) and possible risk factors. This study also includes a comparison with simple coiling group during the same period to estimate the impact of NAS on the occurrence of SEI. Methods : This study included a total of 96 unruptured intracranial aneurysms in 96 patients treated with SAC using NAS. Correlations of demographic data, aneurysm characteristics, and angiographic parameters with properties of SEI were analyzed. The incidence and characteristics of SEI were investigated in 28 patients who underwent simple coiling during the same period, and the results were compared with the SAC group. Results : In the diffusion-weighted imaging obtained on the 1st day after SAC, a total of 106 SEI lesions were observed in 48 (50%) of 96 patients. Of these 48 patients, 38 (79.2%) had 1-3 lesions. Of 106 lesions, 74 (69.8%) had a diameter less than 3 mm. SEI occurred more frequently in older patients (≥60 years, p=0.013). The volume of SEI was found to be significantly increased in older age (≥60 years, p=0.032), hypertension (p=0.036), and aneurysm size ≥5 mm (p=0.047). The incidence and mean volume of SEI in the SAC group (n=96) were similar to those of the simple coiling group (n=28) during the same period. Conclusion : SEIs are common after NAS-assisted coiling. Their incidence in SAC was comparable to that in simple coiling. They occurred more frequently at an older age. Therefore, the use of NAS in the treatment of unruptured intracranial aneurysm does not seem to be associated with an increased risk of thromboembolic events if antiplatelet premedication has been performed well.

Keywords

References

  1. Altay T, Kang HI, Woo HH, Masaryk TJ, Rasmussen PA, Fiorella DJ, et al. : Thromboembolic events associated with endovascular treatment of cerebral aneurysms. J Neurointerv Surg 3 : 147-150, 2011 https://doi.org/10.1136/jnis.2010.003616
  2. Bendszus M, Koltzenburg M, Burger R, Warmuth-Metz M, Hofmann E, Solymosi L : Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study. Lancet 354 : 1594-1597, 1999 https://doi.org/10.1016/S0140-6736(99)07083-X
  3. Burkhardt JK, Srinivasan V, Srivatsan A, Albuquerque F, Ducruet AF, Hendricks B, et al. : Multicenter postmarket analysis of the neuroform atlas stent for stent-assisted coil embolization of intracranial aneurysms. AJNR Am J Neuroradiol 41 : 1037-1042, 2020 https://doi.org/10.3174/ajnr.A6581
  4. Cho SH, Jo WI, Jo YE, Yang KH, Park JC, Lee DH : Bench-top comparison of physical properties of 4 commercially-available self-expanding intracranial stents. Neurointervention 12 : 31-39, 2017 https://doi.org/10.5469/neuroint.2017.12.1.31
  5. Cronqvist M, Wirestam R, Ramgren B, Brandt L, Nilsson O, Saveland H, et al. : Diffusion and perfusion MRI in patients with ruptured and unruptured intracranial aneurysms treated by endovascular coiling: complications, procedural results, MR findings and clinical outcome. Neuroradiology 47 : 855-873, 2005 https://doi.org/10.1007/s00234-005-1408-2
  6. Derdeyn CP, Cross DT 3rd, Moran CJ, Brown GW, Pilgram TK, Diringer MN, et al. : Postprocedure ischemic events after treatment of intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 96 : 837-843, 2002 https://doi.org/10.3171/jns.2002.96.5.0837
  7. Hahnemann ML, Ringelstein A, Sandalcioglu IE, Goericke S, Moenninghoff C, Wanke I, et al. : Silent embolism after stent-assisted coiling of cerebral aneurysms: diffusion-weighted MRI study of 75 cases. J Neurointerv Surg 6 : 461-465, 2014 https://doi.org/10.1136/neurintsurg-2013-010820
  8. Hou K, Yu J : Application of the neuroform atlas stent in intracranial aneurysms: current status. Front Neurol 13 : 829143, 2022 https://doi.org/10.3389/fneur.2022.829143
  9. Iosif C, Lecomte JC, Pedrolo-Silveira E, Mendes G, Boncoeur Martel MP, Saleme S, et al. : Evaluation of ischemic lesion prevalence after endovascular treatment of intracranial aneurysms, as documented by 3-T diffusion-weighted imaging: a 2-year, single-center cohort study. J Neurosurg 128 : 982-991, 2018
  10. Jankowitz BT, Jadhav AP, Gross B, Jovin TG, Alhajeri AA, Fraser JF, et al. : Pivotal trial of the Neuroform Atlas stent for treatment of posterior circulation aneurysms: one-year outcomes. J Neurointerv Surg 14 : 143-148, 2022 https://doi.org/10.1136/neurintsurg-2020-017115
  11. Kang DH, Kim BM, Kim DJ, Suh SH, Kim DI, Kim YS, et al. : MR-DWI-positive lesions and symptomatic ischemic complications after coiling of unruptured intracranial aneurysms. Stroke 44 : 789-791, 2013 https://doi.org/10.1161/STROKEAHA.112.669853
  12. Kim B, Kim K, Jeon P, Kim S, Kim H, Byun H, et al. : Thromboembolic complications in patients with clopidogrel resistance after coil embolization for unruptured intracranial aneurysms. AJNR Am J Neuroradiol 35 : 1786-1792, 2014 https://doi.org/10.3174/ajnr.A3955
  13. Kim MS, Jo KI, Yeon JY, Kim JS, Kim KH, Jeon P, et al. : Association between postprocedural infarction and antiplatelet drug resistance after coiling for unruptured intracranial aneurysms. AJNR Am J Neuroradiol 37 : 1099-1105, 2016 https://doi.org/10.3174/ajnr.A4777
  14. Kwon O, Chung J : Outcomes of stent-assisted coiling using the neuroform atlas stent in unruptured wide-necked intracranial aneurysms. J Korean Neurosurg Soc 64 : 23-29, 2021 https://doi.org/10.3340/jkns.2020.0054
  15. Lee SH, Jang MU, Kang J, Kim YJ, Kim C, Sohn JH, et al. : Impact of reducing the procedure time on thromboembolism after coil embolization of cerebral aneurysms. Front Neurol 9 : 1125, 2018 https://doi.org/10.3389/fneur.2018.01125
  16. Lefevre PH, Schramm P, Kemmling A, Barreau X, Marnat G, Piotin M, et al. : Multi-centric European post-market follow-up study of the Neuroform Atlas Stent System: primary results. J Neurointerv Surg 14 : 694-698, 2022 https://doi.org/10.1136/neurintsurg-2021-017849
  17. Lei C, Deng Q, Li H, Zhong L : Association between silent brain infarcts and cognitive function: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis 28 : 2376-2387, 2019 https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.03.036
  18. Nii K, Inoue R, Morinaga Y, Mitsutake T, Hanada H : Evaluation of acute in-stent thrombosis during stent-assisted coil embolization of unruptured intracranial aneurysms. Neurol Med Chir (Tokyo) 58 : 435-441, 2018 https://doi.org/10.2176/nmc.oa.2018-0131
  19. Park JC, Lee DH, Kim JK, Ahn JS, Kwun BD, Kim DY, et al. : Microembolism after endovascular coiling of unruptured cerebral aneurysms: incidence and risk factors. J Neurosurg 124 : 777-783, 2016 https://doi.org/10.3171/2015.3.JNS142835
  20. Qureshi AI, Luft AR, Sharma M, Guterman LR, Hopkins LN : Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: part I--pathophysiological and pharmacological features. Neurosurgery 46 : 1344-1359, 2000 https://doi.org/10.1097/00006123-200006000-00012
  21. Schubert GA, Thome C, Seiz M, Douville C, Eskridge J : Microembolic signal monitoring after coiling of unruptured cerebral aneurysms: an observational analysis of 123 cases. AJNR Am J Neuroradiol 32 : 1386-1391, 2011 https://doi.org/10.3174/ajnr.A2507
  22. Seo DH, Yoon SM, Park HR, Shim JJ, Bae HG, Yun IG : Thromboembolic event detected by diffusion weighted magnetic resonance imaging after coil embolization of cerebral aneurysms. J Cerebrovasc Endovasc Neurosurg 16 : 175-183, 2014 https://doi.org/10.7461/jcen.2014.16.3.175
  23. Tokunaga K, Hatano T, Nakahara I, Ishii A, Higashi E, Kamata T, et al. : Factors associated with postprocedural diffusion-weighted imagingpositive lesions in endovascular treatment for unruptured cerebral aneurysms. World Neurosurg 130 : e457-e462, 2019 https://doi.org/10.1016/j.wneu.2019.06.114
  24. Vermeer SE, Longstreth WT Jr, Koudstaal PJ : Silent brain infarcts: a systematic review. Lancet Neurol 6 : 611-619, 2007 https://doi.org/10.1016/S1474-4422(07)70170-9
  25. Zaidat OO, Hanel RA, Sauvageau EA, Aghaebrahim A, Lin E, Jadhav AP, et al. : Pivotal trial of the neuroform atlas stent for treatment of anterior circulation aneurysms: one-year outcomes. Stroke 51 : 2087-2094, 2020 https://doi.org/10.1161/STROKEAHA.119.028418
  26. Zhang Y, Wang C, Tian Z, Zhu W, Li W, Yang X, et al. : Risk factors for periprocedural ischemic stroke following endovascular treatment of intracranial aneurysms. Chin Neurosurg J 7 : 38, 2021  https://doi.org/10.1186/s41016-021-00255-z