Adjunctive therapy demonstrates comparable aneurysm occlusion rates to established flow diverters

Thomas Liebig

The Neqstent coil-assisted flow diverter (Cerus Endovascular) has demonstrated comparable occlusion rates to those seen with other, similar flow diversion technologies, as well as positive device stability and safety outcomes. These new data were presented by Thomas Liebig (Ludwig Maximilian University, Munich, Germany) at this year’s European Society of Minimally Invasive Neurological Therapy (ESMINT) congress (7–9 September, Nice, France).

Liebig began his presentation by outlining the use of Neqstent as an adjunctive therapy in the treatment of intracranial aneurysms, claiming that this technique intends to provide stable aneurysm neck coverage for the placement of embolisation coils as well as long-term aneurysm occlusion. He also described Neqstent as the “smaller brother” of Cerus’ Contour device, owing to the latter having a higher mesh density.

The CAFI study—for which Liebig is the principal investigator—was set up to assess the performance of the 7mm, 9mm and 11mm iterations of the Neqstent device. According to Liebig, this prospective, multicentre, single-arm study was conducted across several European centres, including in Austria, Denmark, Germany and Switzerland, while some cases from Canada were also added.

All 38 patients enrolled in the CAFI study had non-ruptured bifurcation aneurysms, with Liebig noting a female predominance, an average age of roughly 60 years old, and no neurological deficits, in the intention-to-treat cohort. He added that the most common aneurysm locations were the anterior communicating artery (Acom) and basilar artery tip, followed by the middle cerebral artery (MCA), and that—on average—the aneurysms seen in the study were “not very large”.

“The majority [of patients] were treated with a 7mm or 9mm device, and this was successful at the first attempt in almost 90% of cases,” Liebig reported. “In two patients, it was not possible to place the device due to anatomical issues.” He later detailed difficulties in expanding the device in one of these two cases, illustrating a problem that may be encountered when treating aneurysm recurrences following prior implantation of a Woven EndoBridge (WEB; Microvention) device—something that has also previously been observed with Contour.

The primary safety endpoint was ischaemic event with ongoing symptoms at last follow-up, he continued, and—across the 36 patients who successfully underwent Neqstent implantation—this occurred in two patients within the first six months after the procedure. There were no non-accidental or neurological deaths. “In terms of device stability, there was only one case where the device, together with the coils, had moved up at follow-up—leading to a neck remnant that did not [require] treatment,” Liebig added.

Occlusion rates were assessed using both the Raymond-Roy (RR) and WEB occlusion scales, according to the speaker, who reported that Neqstent yielded similar occlusion results to those seen previously with the Contour and WEB devices, demonstrating a combined RR1+2 rate of 86.2% and a WEB occlusion rate of 83.4% at the six-month follow-up timepoint. He added that six-month follow-up data were available for all 36 patients, but 12-month follow-up data are currently only available for six of the included patients.

“We have to collect a few more 12-month follow-ups,” Liebig concluded, “but we are fairly happy with our results so far—especially [the fact] there was only one device movement leading to a neck remnant.”

Responding to a question from session moderator Riitta Rautio (Turku University Hospital, Turku, Finland) on repositioning the Neqstent device after it has been implanted, Liebig said this is “possible”, but the geometry of the aneurysm tends to dictate the implant’s positioning. “To some extent, you can influence this with the position of your microcatheter,” he added. “But, in most cases, it was not actually necessary to reposition [the device].”


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