title: Neuroform intracranial stenting for aneurysms using simple and multi-stent technique is associated with low risk of magnetic resonance diffusion-weighted imaging lesions.
abstract: BACKGROUND
  Detection of procedural thromboembolism by diffusion-weighted magnetic resonance imaging (MR-DWI+) can help identify and mitigate endovascular risk factors. Data remain scant on procedural MR-DWI+ following the use of the Neuroform open-cell design stent in aneurysm embolization.
  
  
  OBJECTIVE
  We sought to evaluate the incidence of MR-DWI+ in Neuroform simple and multi-stent construct stenting for intracranial aneurysms in an attempt to delineate baseline risk and identify possible associated procedural factors.
  
  
  METHODS
  Seventy-six patients receiving 97 Neuroform stents in the treatment of intracranial aneurysm were identified from a prospective database and eligible for inclusion in the study. Diffusion-weighted magnetic resonance imaging (MR-DWI) was obtained in all patients within 48 hours of the procedure and reviewed for the presence of MR-DWI+ with patient records reviewed for analysis of factors predisposing to these lesions.
  
  
  RESULTS
  Patients were treated with single-stent Neuroform constructs in 57 cases (73%) and multi-stent Neuroform constructs in 21 cases (27%). Y-stent technique was used in 16 cases. MR-DWI+ was identified in 7 of 78 cases (9.0%), with MR-DWI+ in 0 of 10 subarachnoid hemorrhage cases. No MR-DWI lesions led to a permanent neurological deficit at discharge. There was no MR-DWI+ in patients treated with Y-stenting or multi-stent Neuroform constructs. The only factor associated with ipsilateral MR-DWI+ was target aneurysm location on an arterial sidewall over bifurcation (P = .01).
  
  
  CONCLUSIONS
  The Neuroform stent carries a very low risk of MR-DWI+ compared with its closed-cell design counterpart. Subarachnoid hemorrhage and deployment of multiple stents in the same anatomical region in configurations such as the Y-stent construct did not increase the risk of acute procedural thromboembolism.
authors.affiliation: Cerebrovascular and Endovascular Division, Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Heller
authors.forename: Venkata
authors.initials: V
authors.lastname: Dandamudi
authors.forename: Daniel
authors.initials: D
authors.lastname: Calnan
authors.forename: Adel M
authors.initials: AM
authors.lastname: Malek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D038524:Diffusion Magnetic Resonance Imaging; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D013923:Thromboembolism / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*