Improved delivery of the Neuroform 3 stent: Technical note

Background: Intracranial stents have expanded endovascular therapy to wide neck aneurysms whose dimensions and configurations are not amendable to coil embolization alone. Stents however have not eliminated all problems due to technical factors with their delivery systems. The Neuroform stent system is one of the most widely used for this purpose and has undergone several technical modifications to improve deliverability. Despite improvements in the delivery system there are still reports of failure of stent deployment with the Neuroform 3. Here a simple back table modification is described in which the stent is pushed several centimeters back into the delivery catheter from its manufactured location. This makes the catheter tip more flexible and in our experience improves navigation through vessel curvature and increases deployment rate. Methods: Our institution's cerebrovascular database was reviewed retrospectively in compliance with institutional review board approval to identify all Neuroform 3 stents used for assistance with aneurysm embolization since the current stent design became clinically available. Records were reviewed to identify cases of failure of stent placement using the above described technical modification. Results: 139 Neuroform 3 stents were placed at our institution for assistance with aneurysm embolization with the technique described above. Only three instances of failure of stent placement related to trackability of the delivery system were identified for a technical failure rate of 2.2%. Conclusions: A simple back table modification to the Neuroform 3 delivery system is described which in our single center experience may improve trackability and ultimately successful stent deployment.