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Stent-Assisted Coiling of Intracranial Aneurysms Using a Nitinol-Based Stent (Neuroform Atlas): A Systematic Review and Meta-analysis

  • Clinical Investigation
  • Stroke/Neurointerventions
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Abstract

Objective

The aim of this systematic review and meta-analysis was to synthesize the latest evidence on the efficacy and safety of Neuroform Atlas-assisted coiling of intracranial aneurysms.

Methods

We performed a comprehensive search for articles that assessed the efficacy and safety of Neuroform Atlas-assisted coiling of intracranial aneurysms. The outcome measurement was adequate occlusion, defined as Raymond–Roy Class I (RR1) + Raymond–Roy Class II (RR2) by previous studies.

Results

A total of 557 patients (568 aneurysms) from 13 studies were included. The rate of adequate occlusion after the procedure was 88% (83–94%, I2: 72.21%), and the rates of RR1 and RR2 were 68% (60–77%, I2: 81.87%) and 21% (15–27%, I2: 66.10%), respectively. The adequate occlusion rate at 6 months was 90% (81–99%, I2: 58.04%) and 93% (91–96%, I2: 0%) at the end of a mean of 9.03 ± 1.03 months of follow-up. Periprocedural complications occurred in 35 patients [5% (3–8%, I2: 21.28%)]. Subgroup analysis of unruptured aneurysms showed that the rates of adequate occlusion were 85% (78–93%), 90% (79–100%) (6-month follow-up), and 93% (90–96%) (at the end of follow-up). For the wide-necked aneurysm subgroup, the rate of adequate occlusion was 86% (80–93%) and was 93% (89–97%) at the end of follow-up. Meta-regression showed that initial adequate occlusion was influenced by mean aneurysm neck size (p = 0.034).

Conclusion

Neuroform Atlas-assisted coiling is associated with an initial adequate occlusion rate of 88% and a periprocedural complication rate of 6%. The rate of initial adequate occlusion was 85% in unruptured aneurysms and 86% in wide-necked aneurysms.

Level of Evidence

Level 2, Systematic review of non-randomized and single-arm studies.

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This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Faculty of Medicine, Universitas Pelita Harapan, Jl. Jend. Sudirman No. 20, Tangerang, Banten, 15810, Indonesia

    Raymond Pranata & Rachel Vania

  2. Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia

    Emir Yonas

  3. Faculty of Medicine, Universitas Gadjah Mada, Jogjakarta, Indonesia

    Hadrian Deka

  4. Department of Neurosurgery, Neuroscience Centre Siloam Hospital, Medical Faculty of Pelita Harapan University, Lippo Village, Tangerang, Indonesia

    Julius July

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Pranata, R., Yonas, E., Deka, H. et al. Stent-Assisted Coiling of Intracranial Aneurysms Using a Nitinol-Based Stent (Neuroform Atlas): A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 43, 1049–1061 (2020). https://doi.org/10.1007/s00270-020-02502-9

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