Endovascular Treatment of Wide-Necked Intracranial Aneurysms Using the Novel Contour Neurovascular System: Five Year Follow Up

BACKGROUND AND PURPOSE: The contour neurovascular embolization device is a novel way to treat wide-necked bifurcation aneurysms (WNBA), which often pose significant treatment challenges. In this study, we aim to evaluate the efficacy and safety profile of this device.

MATERIALS AND METHODS: Prospective clinical and radiological data was collected for all patients treated with the Contour device at our centre, between January 2017 and December 2018. All patients were treated electively, and aneurysms were unruptured.

RESULTS: Fourteen patients were recruited, and the device was successfully deployed in eleven patients. All patients were women with a mean age of 65 years. Four basilar tip, two internal carotid, three middle cerebral, one anterior communicating, and one superior cerebellar artery aneurysms were treated. The mean aneurysmal size was 6mm (width) x 7.6mm (height), with 4.1mm neck. Follow-up imaging included DSA, MRA and CTA. For the 9 patients available at year two follow-up, 5 showed improved occlusion class over time with 8 of 9 having adequate occlusion defined by class 1 and 2 of the Raymond-Roy (R-R) classification system. Eight patients were available for 3-year follow-up: 7 patients had stable occlusion class including 3 patients with stable complete occlusion (R-R class 1). One patient had worsening of R-R occlusion class from 1 to 2 and subsequently presented with acute subarachnoid hemorrhage. Follow up data 5 years following implantation was available for 8 patients (including the ruptured and retreated patient): 7 patients had adequate occlusion (R-R class 1 and 2), however one patient had worsened from R-R class 1 to R-R class 2. Four patients had complete occlusion.

CONCLUSIONS: Results demonstrate progressive occlusion of wide-necked aneurysms over the first 2 years, but we have also demonstrated worsening of Raymond-Roy occlusion class in some aneurysms that were previously completely occluded. Our results suggest that the contour device is a good option in WNBA, however, it appears that patients must be followed up for a minimum of 5 years.

ABBREVIATIONS: WNBA = wide neck bifurcation aneurysms; WEB = Woven EndoBridge; CNS = Contour Neurovascular System; GCS =Glasgow Coma Scale; ACOM = anterior communicating artery; SCA = superior cerebellar artery; R-R = Raymond-Roy.