Neuroform Atlas single-stent coiling for wide-neck MCA bifurcation aneurysms: a retrospective single-centre case series

Abstract

Background

Wide-neck aneurysms at the middle cerebral artery (MCA) bifurcation pose a recognized challenge for endovascular treatment. Y- or X-stent configurations can reconstruct the bifurcation but increase procedural complexity and complication risk. The Neuroform Atlas is a low-profile, open-cell stent that allows single-stent neck reconstruction through 0.0165-inch microcatheters. Evidence on its performance in Chinese patients remains limited.

Methods

We conducted a retrospective, single-centre case series of 15 consecutive patients with wide-neck MCA bifurcation aneurysms treated with Neuroform Atlas stent-assisted coiling at the Aviation General Hospital (Beijing, China) between October 2023 and February 2025. Inclusion criteria were aneurysm neck >4 ​mm or dome-to-neck ratio <1.5, age 18–75 years and ability to comply with follow-up; both ruptured (Hunt–Hess I–III) and unruptured aneurysms were included. Fourteen aneurysms were treated with a single stent and one required Y-stenting. The primary endpoint was complete occlusion (Raymond grade I) at 6-month angiographic follow-up; secondary endpoints included periprocedural thromboembolic or haemorrhagic events, functional outcome measured by the modified Rankin Scale (mRS) and the need for retreatment. Data were summarised descriptively.

Results

Patients had a median age of 61 years (range 30–75 years) and were predominantly female (73 ​%). Aneurysms had a median neck width of 4.2 ​mm and mean maximum diameter of 5.16 ​mm; 40 ​% presented with subarachnoid haemorrhage. Technical success was 100 ​%, with 14/15 aneurysms treated using a single stent. Immediate or follow-up angiography showed Raymond grade I occlusion in all cases. No periprocedural thromboembolic or haemorrhagic events were observed, all patients achieved mRS ≤2 ​at last follow-up, and no recurrences or retreatments were required.

Conclusions

In this small retrospective series, Neuroform Atlas single-stent-assisted coiling was feasible and achieved complete occlusion with no procedure-related complications in wide-neck MCA bifurcation aneurysms. These preliminary results suggest the approach may offer a safe and effective alternative to complex dual-stenting techniques, but larger prospective studies with control groups are needed to confirm its generalizability.