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Neuroform Intracranial Stenting for Aneurysms Using Simple and Multi-stent Technique Is Associated With Low Risk of Magnetic Resonance Diffusion-Weighted Imaging Lesions

Heller, Robert S. MD; Dandamudi, Venkata MD; Calnan, Daniel PhD; Malek, Adel M. MD, PhD

doi: 10.1227/NEU.0000000000000053
Research-Human-Clinical Studies

BACKGROUND: Detection of procedural thromboembolism by diffusion-weighted magnetic resonance imaging (MR-DWI+) can help identify and mitigate endovascular risk factors. Data remain scant on procedural MR-DWI+ following the use of the Neuroform open-cell design stent in aneurysm embolization.

OBJECTIVE: We sought to evaluate the incidence of MR-DWI+ in Neuroform simple and multi-stent construct stenting for intracranial aneurysms in an attempt to delineate baseline risk and identify possible associated procedural factors.

METHODS: Seventy-six patients receiving 97 Neuroform stents in the treatment of intracranial aneurysm were identified from a prospective database and eligible for inclusion in the study. Diffusion-weighted magnetic resonance imaging (MR-DWI) was obtained in all patients within 48 hours of the procedure and reviewed for the presence of MR-DWI+ with patient records reviewed for analysis of factors predisposing to these lesions.

RESULTS: Patients were treated with single-stent Neuroform constructs in 57 cases (73%) and multi-stent Neuroform constructs in 21 cases (27%). Y-stent technique was used in 16 cases. MR-DWI+ was identified in 7 of 78 cases (9.0%), with MR-DWI+ in 0 of 10 subarachnoid hemorrhage cases. No MR-DWI lesions led to a permanent neurological deficit at discharge. There was no MR-DWI+ in patients treated with Y-stenting or multi-stent Neuroform constructs. The only factor associated with ipsilateral MR-DWI+ was target aneurysm location on an arterial sidewall over bifurcation (P = .01).

CONCLUSION: The Neuroform stent carries a very low risk of MR-DWI+ compared with its closed-cell design counterpart. Subarachnoid hemorrhage and deployment of multiple stents in the same anatomical region in configurations such as the Y-stent construct did not increase the risk of acute procedural thromboembolism.

ABBREVIATIONS: DWI, diffusion-weighted imaging

MR-DWI, diffusion-weighted magnetic resonance imaging

MR-DWI+, magnetic resonance diffusion-weighted imaging hyperintense lesion

SAH, subarachnoid hemorrhage

Cerebrovascular and Endovascular Division, Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts

Correspondence: Adel M. Malek, MD, PhD, Department of Neurosurgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111. E-mail: amalek@tuftsmedicalcenter.org

Received January 7, 2013

Accepted June 5, 2013

Copyright © by the Congress of Neurological Surgeons