Complications and adverse events associated with Neuroform stent-assisted coiling of wide-neck intracranial aneurysms

Background: Successful experiences of the Neuroform stent-assisted coiling have been reported by many teams in endovascular neurosurgery centers throughout the world. However, most of the reported complications involved a limited number of patients. Objective: To systematically report the complications of Neuroform stent-assisted coiling of intracranial aneurysms and to tentatively assess the efficacy and safety of this method. Methods: A retrospective study of 232 consecutive patients with 239 wide-neck aneurysms treated with Neuroform stent-assisted coil embolization at our institution over a 6-year period was performed. Angiographic results and clinical outcome were evaluated. Cases with complications were analyzed. Results: Stenting was successful in 237 of 239 aneurysms. Favorable clinical outcome (modified Rankin score: 0-2) was observed in 88.3% of the patients. Procedure-related complications included thromboembolism (n=13), intraprocedural rupture (n=8), coil protrusions (n=5), new mass effect (n=3), vessel injury (n=3), and stent dislodgement (n=2). Procedure-related morbidity and mortality were 4.2 and 1.3%, respectively. Non-procedural complications attributable to subarachnoid hemorrhage in 129 patients with ruptured aneurysms were symptomatic vasospasm (18.6%) and shunt-dependent hydrocephalus (6.9%). Angiography follow-up was obtained in 67.1% of the treated aneurysms. The overall recanalization rate was 14.5%. Delayed complications included in-stent stenosis (n=2) and penetrating artery occlusion (n=2) in follow-up period. Conclusion: Neuroform sent-assisted coiling of intracranial aneurysm is a safe technique with relatively low recanalization rate. The main cause of morbidity and mortality is thromboembolism. Long-term effect on parent artery should be observed carefully.