Single Stent-Assisted Coiling for the Treatment of Complex, Acute-Angled Wide-Necked Intracranial Bifurcation Aneurysms Using the Bulging Technique with the Neuroform Atlas Stent.
AIM Protecting both bifurcation branches with a single device is challenging when the neck of an intracranial aneurysm is centered at a bifurcation and forms an acute angle. This study aimed to evaluate the efficacy of the bulging technique using a single Neuroform Atlas stent to protect two branches in complex, acute-angled, wide-necked bifurcation aneurysms (WNBAs). METHODS We retrospectively reviewed patients with complex, acute-angled WNBAs who underwent single stent-assisted coiling using the bulging technique with a Neuroform Atlas stent between August 2020 and July 2024. Technical feasibility, procedure-related complications, and angiographic and functional outcomes were evaluated. RESULTS A total of 52 eligible patients were enrolled, including 22 (42.3%) with acutely ruptured aneurysms. The bulging technique was successfully implemented in all cases. Initial angiographic assessment demonstrated complete occlusion in 33 (63.5%) cases, neck remnants in 14 (26.9%) cases, and residual aneurysms in 5 (9.6%) cases. Angiographic follow-up was available for 48 (92.3%) patients, with a median follow-up duration of 6.4 months. Follow-up angiography demonstrated complete occlusion in 42 (87.5%) patients and neck remnants in 6 (12.5%) patients. Procedure-related complications occurred in 2 (3.8%) patients and consisted of ischemic events. Favorable functional outcomes (modified Rankin Scale score, 0-2) were achieved in 48 (92.3%) patients during follow-up. No cases of permanent procedure-related morbidity or mortality were observed. CONCLUSIONS The bulging technique using a single Neuroform Atlas stent appears to be a feasible and safe treatment for complex, acute-angled WNBAs, with satisfactory short-term angiographic and clinical outcomes. However, further studies with longer follow-up durations are warranted to establish its long-term efficacy.