Long-term results of enterprise stent-assisted coiling of cerebral aneurysms.

BACKGROUND The Enterprise Vascular Reconstruction Device and Delivery System (Cordis; the Enterprise stent) was approved for use in conjunction with coiling of wide-necked aneurysms in 2007. No published long-term aneurysm occlusion or complication data exist for the Enterprise system. OBJECTIVE We compiled data on consecutive patients treated with Enterprise stent-assisted coiling of aneurysms from 9 high-volume neurointerventional centers. METHODS A 9 center registry was created to evaluate large volume data on the delayed safety and efficacy of the Enterprise stent system. Pooled data were compiled for consecutive patients undergoing Enterprise stent-assisted coiling at each institution prior to May 2009. RESULTS Two-hundred twenty-nine patients with 229 aneurysms, 32 of which were ruptured aneurysms, were included in the study. Mean clinical and angiographic follow-up was 619.6 ± 26.4 days and 655.7 ± 25.2 days, respectively. Mean aneurysm size was 9.2 ± 0.4 mm. Fifty-nine percent of patients demonstrated 100% coil obliteration and 81% had 90% or higher occlusion at last follow-up angiography. A total of 19 patients (8.3%) underwent retreatment of their aneurysms during the follow-up period. Angiographic in-stent stenosis was seen in 3.4% and thromboembolic events occurred in 4.4%. Overall, 90% of patients who underwent Enterprise-assisted coiling had a modified Rankin Scale score of 2 or less at last follow-up. A poor modified Rankin Scale score was strongly associated with rupture status (P < .001). CONCLUSION Although this study is limited by its retrospective nature, the Enterprise stent system appears to be an effective, safe, and durable treatment for intracranial aneurysms when used in conjunction with coiling.

[1]  X. Lv,et al.  Results of endovascular treatment for intracranial wide-necked saccular and dissecting aneurysms using the Enterprise stent: a single center experience. , 2012, European journal of radiology.

[2]  K. Fargen,et al.  Delayed Thrombosis or Stenosis Following Enterprise-Assisted Stent-Coiling: Is It Safe? Midterm Results of the Interstate Collaboration of Enterprise Stent Coiling , 2011, Neurosurgery.

[3]  A M Malek,et al.  Parent Vessel Size and Curvature Strongly Influence Risk of Incomplete Stent Apposition in Enterprise Intracranial Aneurysm Stent Coiling , 2011, American Journal of Neuroradiology.

[4]  J. Mocco,et al.  Stent-Associated Flow Remodeling Causes Further Occlusion of Incompletely Coiled Aneurysms , 2011, Neurosurgery.

[5]  J. Wardlaw,et al.  Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial , 2011, The Lancet.

[6]  Raphaël Blanc,et al.  Stent-Assisted Coiling of Intracranial Aneurysms: Clinical and Angiographic Results in 216 Consecutive Aneurysms , 2010, Stroke.

[7]  H. Woo,et al.  Neuroform stent assisted aneurysm treatment: evolving treatment strategies, complications and results of long term follow-up , 2009, Journal of NeuroInterventional Surgery.

[8]  J. Mocco,et al.  Treatment of intracranial aneurysms with the Enterprise stent: a multicenter registry. , 2009, Journal of neurosurgery.

[9]  J. Gabrillargues,et al.  Feasibility, Procedural Morbidity and Mortality, and Long-Term Follow-Up of Endovascular Treatment of 321 Unruptured Aneurysms , 2008, American Journal of Neuroradiology.

[10]  J. Steel,et al.  Complications of Neuroform Stent in Endovascular Treatment of Intracranial Aneurysms , 2008, Neurocritical care.

[11]  P. Gurbel,et al.  Antiplatelet therapy after implantation of drug-eluting stents: duration, resistance, alternatives, and management of surgical patients. , 2007, The American journal of cardiology.

[12]  B. Bendok,et al.  THE EFFECT OF VASCULAR RECONSTRUCTION DEVICE‐ASSISTED COILING ON PACKING DENSITY, EFFECTIVE NECK COVERAGE, AND ANGIOGRAPHIC OUTCOME: AN IN VITRO STUDY , 2007, Neurosurgery.

[13]  Howard A Riina,et al.  NEUROFORM STENT‐ASSISTED COIL EMBOLIZATION OF WIDE‐NECK INTRACRANIAL ANEURYSMS: STRATEGIES IN STENT DEPLOYMENT AND MIDTERM FOLLOW‐UP , 2007, Neurosurgery.

[14]  H. Woo,et al.  WINGSPAN IN‐STENT RESTENOSIS AND THROMBOSIS: INCIDENCE, CLINICAL PRESENTATION, AND MANAGEMENT , 2007, Neurosurgery.

[15]  L. Solymosi,et al.  A new self-expanding nitinol stent (Enterprise) for the treatment of wide-necked intracranial aneurysms: initial clinical and angiographic results in 31 aneurysms , 2007, Neuroradiology.

[16]  G. Benndorf,et al.  Stent conformity in curved vascular models with simulated aneurysm necks using flat-panel CT: an in vitro study. , 2007, AJNR. American journal of neuroradiology.

[17]  H. Woo,et al.  Neuroform in-stent stenosis: incidence, natural history, and treatment strategies. , 2006, Neurosurgery.

[18]  V. Katsaridis,et al.  Embolization of acutely ruptured and unruptured wide-necked cerebral aneurysms using the neuroform2 stent without pretreatment with antiplatelets: a single center experience. , 2006, AJNR. American journal of neuroradiology.

[19]  P. Sandercock,et al.  International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion , 2005, The Lancet.

[20]  J. Gabrillargues,et al.  A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils. , 2005, AJNR. American journal of neuroradiology.

[21]  Sean Meagher,et al.  Initial clinical experience with a new self-expanding nitinol stent for the treatment of intracranial cerebral aneurysms: the Cordis Enterprise stent. , 2005, AJNR. American journal of neuroradiology.

[22]  Dong Joon Kim,et al.  Stent-assisted coil embolization of intracranial wide-necked aneurysms , 2005, Neuroradiology.

[23]  D. Fiorella,et al.  Usefulness of the Neuroform Stent for the Treatment of Cerebral Aneurysms: Results at Initial (3–6-mo) Follow-up , 2005, Neurosurgery.

[24]  S. Akpek,et al.  Self-expandable stent-assisted coiling of wide-necked intracranial aneurysms: a single-center experience. , 2005, AJNR. American journal of neuroradiology.

[25]  Carlos Miranda,et al.  Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms. , 2005, Journal of neurosurgery.

[26]  R. Rosenwasser,et al.  Stent-assisted coil placement for unruptured cerebral aneurysms. , 2004, Neurosurgical focus.

[27]  R. Rosenwasser,et al.  ENDOVASCULAR OCCLUSION OF WIDE-NECKED ANEURYSMS WITH A NEW INTRACRANIAL MICROSTENT (NEUROFORM) AND DETACHABLE COILS , 2004, Neurosurgery.

[28]  D. Fiorella,et al.  Preliminary Experience Using the Neuroform Stent for the Treatment of Cerebral Aneurysms , 2004, Neurosurgery.

[29]  Eric J Topol,et al.  Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. , 2002, JAMA.

[30]  S. Yusuf,et al.  Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study ☆ , 2002 .