Embolization of Ruptured and Unruptured Aneurysms with the Contour Neurovascular System—Summary of 106 Cases

Fritz Wodarg; Fernando Bueno Neves; Friederike Gärtner; Naomi Larsen; Sönke Peters; Johannes Hensler; Tristan Klintz; Justus Mahnke; Hajrullah Ahmeti; Alexander Doukas; Olav Jansen; Karim Mostafa

doi:10.3174/ajnr.A8606

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FIG 1.
Patient selection flow chart.
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FIG 2.
Long-term stability of a wide-necked MCA bifurcation aneurysm treated successfully with CNS implantation. This wide-necked MCA bifurcation aneurysm (A, dome-to-neck ratio 1.32) was treated electively with implantation of a 5-mm CNS. At the end of the procedure, residual perfusion was still present (B). In follow-up DSA after 6 months and CTA after 24 months, the aneurysm is seen to be fully occluded (C and D).
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FIG 3.
Long-term occlusion of an ICA tip aneurysm treated with CNS implantation. This wide-necked ICA tip aneurysm (A, dome-to-neck ratio 1.6) was successfully embolized with a 5-mm CNS. At the end of the procedure, beginning aneurysmal thrombosis was seen (B). DSA after 6 months and CTA after 24 months confirmed stable occlusion (C and D).
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FIG 4.
Reperfusion of an ICA aneurysm after CNS implantation treated with placement of a flow-diversion stent. In this patient, a wide-necked aneurysm (dome-to-neck ratio 1.6) located in the posterior wall of the ICA was found and treated with placement of a 9-mm CNS (A). After 6 months, reperfusion on the posterior side of the aneurysm was seen, which was primarily managed with a watch-and-wait strategy (B and C). After 12 months, the reperfusion was seen to be progressive, and a flow-diversion stent was placed over the CNS (star, D), ensuring complete aneurysmal sealing.

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Table 1:

Demographics

	Overall	Elective Cases	Acute Cases
No. of patients	106/106 (100%)	72/106 (67.9%)	34/106 (32.1%)
Men	34 (32.1%)	22 (30.6%)^{^a}	12 (35.3%)^{^b}
Women	72 (67.9%)	50 (69.4%)^{^a}	22 (64.7%)^{^b}
Age	58.2 ± 12.0	58.9 ± 11.9	56.7 ± 12.1
Diabetes mellitus	10 (9.4%)	8 (11.1%)^{^a}	2 (5.8%)^{^b}
Hypertension	51 (48.1%)	39 (54.1%)^{^a}	12 (35.3%)^{^b}
Hyperlipidemia	14 (13.2%)	13 (18.1%)^{^a}	1 (2.9%)^{^b}
History of smoking	22 (20.7%)	17 (23.6%)^{^a}	5 (14.7%)^{^b}
Baseline mRS 0–1	85 (80.1%)	72 (100%)	13 (38.2%)^{^b}
Baseline NIHSS 0–5	88 (83.0%)	72 (100%)	11 (32.3%)^{^b}
Hunt and Hess 1–2			20 (58.8%)^{^b}
Hunt and Hess 3–5			14 (41.2%)^{^b}

↵a Percentages referring to cohort of elective cases.
↵b Percentages referring to cohort of acute cases.

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Table 2:

Aneurysm localization and periprocedural characteristics

Aneurysm characteristics
Total number of aneurysms	109
Mean neck width in mm	3.9 (1.7–11.6)
Mean dome width in mm	6.7 (2.5–24.2)
Mean dome-to-neck ratio	1.7 (0.9–3.5)
Aneurysm localization
Anterior circulation	89/109 (81.7%)
Posterior circulation	20/109 (18.3%)
Sidewall	21/109 (19.2%)
Bifurcation	88/109 (80.8%)
Periprocedural characteristics
Mean total procedure time in minutes	78 (23–209)
Mean Contour time in minutes	33 (4–172)
Mean radiation dose in cGy/cm2	7886.3 (277–197,177)
Contour size 5	21/109 (19.8%)
Contour size 7	35/109 (32.7%)
Contour size 9	26/109 (24.2%)
Contour size 11	16/109 (14.9%)
Contour size 14	4/109 (3.7%)
Not implanted	5/109 (4.6%)

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Table 3:

Follow-up results after 6, 12, and 24 months

	Immediate	6 Months	12 Months	24 Months
No. of patients	79/106 (79.2%)	69/106 (65.1%)	44/106 (41.5%)	30/106 (28.3%)
RRS 1/2	54/79 (68.4%)	60/69 (86.9%)	36/44 (81.8%)	29/30 (96.0%)
RRS 1	53/79 (67.1%)	44/69 (63.4%)	24/44 (55.5%	22/30 (73.3%)
RRS 2	1/79 (1.2%)	16/69 (23.1%)	12/44 (27.3%)	8/30 (26.7%)
RRS 3a	25/79 (32%)	4/69 (5.8%)	4/44 (9.0%)	0
RRS 3b	0/79 (0%)	5/69 (7.2%)	4/44 (9.0%)	1/30 (3.3%)
Reintervention	0	5	1	1

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Table 4:
Latest available follow-up results
No. of Patients Median Follow-Up (Months) RRS 1 RRS 2 RRS 3a RRS 3b
76/106 (71.6%) 16.6 (8.2–22.0) 55 (72.3%) 14 (18.4%) 3 (3.9%) 4 (5.2%)
69/76 (90.8%) 7/76 (9.2%)

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Table 5:

Characteristics of nonoccluded aneurysms

No.	Presentation	Localization	Type	Morphology	Adjunctive Devices	DTN	Time to Reintervention (Days)
1	SAH	Basilar tip	Bifurcation	Lobulated	Coils	2.77	100
2	SAH	PcomA	Bifurcation	Saccular	n/a	0.97	139
3	SAH	ICA	Sidewall	Saccular	n/a	1.69	831
4	SAH	PICA	Sidewall	Saccular	n/a	1.73	218
5	Elective	ICA	Sidewall	Saccular	Coils	1.72	520
6	Elective	ICA	Sidewall	Saccular	n/a	2.07	231
7	Elective	PcomA	Bifurcation	Saccular	n/a	1.21	247

Note:—PComA indicates posterior communicating artery; n/a, not applicable.

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Table 6:

Periprocedural complications

No.	Presentation	Localization	Type	DNR	Type of Complication	Management
1	SAH	AcomA	Bifurcation	2.41	Thromboembolism	Thrombectomy
2	SAH	AcomA	Bifurcation	1.15	Thromboembolism	Thrombectomy
3	SAH	AcomA	Bifurcation	1.52	Thromboembolism	Thrombectomy
4	SAH	AcomA	Bifurcation	1.73	Aneurysm bleeding	Coiling
5	Elective	ICA	Sidewall	3.03	ICA dissection	Aspirin
6	Elective	ICA	Sidewall	1.71	ICA dissection	Aspirin
7	Elective	ICA	Bifurcation	1.61	Aphasia	Thrombolysis
8	Elective	MCA	Bifurcation	1.65	Light hemiparesis	Self-limiting
	Overall, n (%)		Elective, n (%)		SAH, n (%)
	8/106 (7.5%)		4/72 (5.5%)		4/34 (11.7%)