Neuroform Atlas stent-assisted coiling of wide-necked intracranial bifurcation aneurysms

Objective: To evaluate the safety and efficacy of Neuroform Atlas stent-assisted coiling in the endovascular treatment of wide-necked intracranial bifurcation aneurysms. Methods: We retrospectively reviewed 76 patients with wide-necked intracranial bifurcation aneurysms who underwent Neuroform Atlas stent-assisted coiling at our institution between August 2021 and December 2024. Patient demographics, aneurysm characteristics, procedural details, and procedure-related complications were collected and analyzed. Angiographic and clinical outcomes were assessed both postoperatively and during follow-up. The modified Rankin Scale (mRS) was used to evaluate clinical outcomes, and Raymond-Roy occlusion classification (RROC) grades were used to determine the degree of aneurysm occlusion. Results: A total of 76 patients harboring 81 wide-necked intracranial bifurcation aneurysms were included in the study. Among them, 17 patients (22.4%) presented with subarachnoid hemorrhage (SAH) at admission. A total of 87 Neuroform Atlas stents were successfully deployed in all patients. Immediate post-procedural angiography demonstrated complete occlusion in 69 aneurysms (85.2%, Raymond-Roy class I) and residual neck in 12 aneurysms (14.8%, Raymond-Roy class II). Procedure-related complications occurred in 4 patients (5.3%), including intraprocedural aneurysm rupture in 2 patients (2.6%), coil migration in 1 patient (1.3%), and parent artery hemorrhage in 1 patient (1.3%). Clinical follow-up was available for 72 patients (94.7%) at 6-18 months (mean, 12 months). At the last follow-up, 68 patients (94.4%) had an mRS score of 0, 3 patients (4.2%) had a score of 2, and 1 patient (1.4%) had a score of 3. A favorable clinical outcome (mRS ≤ 2) was achieved in 71 patients (98.6%), whereas 1 patient (1.4%) had a poor outcome (mRS>2). Angiographic follow-up was performed in 68 patients (89.5%) with 73 treated aneurysms (90.1%) at 6-18 months (mean, 12 months) after embolization. Complete occlusion (Raymond-Roy class I) was observed in 69 aneurysms (94.5%), and residual neck (Raymond-Roy class II) was found in 4 aneurysms (5.5%). Conclusion: Neuroform Atlas stent-assisted coiling is a feasible and effective endovascular treatment strategy for wide-necked intracranial bifurcation aneurysms. This technique is associated with high aneurysm occlusion rates, favorable clinical outcomes, and low procedure-related morbidity.