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1. Patient Preparation
3D rotational angiography is one of the pre-procedural imaging techniques used. Unlike stent-assisted procedures, antiplatelet therapy is typically not necessary before the procedure.
The Contour Device
The Contour Device
procedure steps
2. Access to Vascular
Femoral or radial arteries are used to obtain percutaneous arterial access. Proximal to the aneurysm, an 8F guiding catheter is placed and guided.
3. Navigation of Microcatheters
Using a microwire and fluoroscopic guidance, a 0.027" microcatheter is delicately inserted into the aneurysm neck or sac.
4. Aneurysm Dimensions and Device Choice
The choice of the right-sized Contour device, which is enlarged to the aneurysm's equatorial plane, is guided by the aneurysm's neck and maximum diameter measurements from imaging.
5. Deployment of Devices
After passing through the microcatheter and being unsheathed, the Contour device—a dual-layer nitinol micro-braided mesh with a platinum core—expands into a cup-like form that fills the aneurysm neck and reconstructs the bifurcation.
6. Placing and Adjusting
To prevent aneurysm dome manipulation and maximize occlusion, the device position is verified during deployment and modified by resheathing and redeployment if necessary.
7. Disconnection
The gadget is electrolytically separated from the delivery wire after it is at the ideal place.
8. Angiographic Evaluation
To verify parent vascular patency, aneurysm flow interruption, and device insertion, immediate angiography is carried out.
9. Hemostasis and Catheter Removal
Hemostasis is attained at the access site, and microcatheters and guiding catheters are carefully removed
10. After-Procedure Care
Short-term aspirin (e.g., six weeks) is usually administered to patients without long-term dual antiplatelet medication. To evaluate occlusion and safety, clinical and imaging follow-up is carried out at six months, a year, and two years.
disease treated
Brain Aneurysm
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suitable for
Therapy for wide-neck bifurcation intracranial aneurysms
Therapy for wide-neck bifurcation intracranial aneurysms (WNBAs), particularly those that have not ruptured.
Aneurysms that have dome-to-neck ratios
Aneurysms that have dome-to-neck ratios higher than 1.6, including several narrow-neck aneurysms that were first indicated as wide-neck.
Places such the internal carotid artery terminal
Places such the internal carotid artery terminal, basilar apex, anterior communicating artery, and middle cerebral artery.
Patients who would benefit from a less invasive endovascular procedure
Patients who would benefit from a less invasive endovascular procedure without long-term dual antiplatelet therapy.
Circumstances where it is advantageous to use smaller
Circumstances where it is advantageous to use smaller 0.027″ microcatheters for easier procedure planning and placement.
Situations when the device's solid location and easier sizing
Situations when the device’s solid location and easier sizing are better than those of other intrasaccular devices.
Aneurysm morphology and operator experience
Aneurysm morphology and operator experience are taken into account for both elective treatment and a few cases of acute (ruptured) aneurysms.
benefits
Simple Planning and Sizing
Procedural planning is simple because the Contour device requires sizing based primarily on the aneurysm neck and widest equatorial diameter.
Navigable and Minimal Invasive
It improves delivery success by using tiny 0.027″ microcatheters that make it easier to access distal or convoluted aneurysms.
Disruption and Diversion of Dual Flow
The device improves occlusion efficacy by acting as a flow diverter at the aneurysm neck and a flow disruptor inside the aneurysm sac.
Decreased Requirement for Supplementary Devices
Contour frequently makes the process simpler and less complicated by doing away with the necessity for extra coils or stents.
Reduced Antiplatelet Treatment
Long-term dual antiplatelet therapy is typically not required because it has a significant parent vascular component, which is advantageous for individuals who are at risk of bleeding.
High Rates of Occlusion
In comparison to other devices such as WEB, studies show progressive and persistent aneurysm occlusion reaching 80% at one year.
Reduced Process Time
Its design reduces process duration and potential difficulties by enabling quicker deployment and less procedural manipulation.
Adequate for Bifurcation Aneurysms in the Wide Neck
It successfully targets the aneurysm neck, particularly in difficult bifurcation sites like the anterior communicating artery and middle cerebral artery.
Secure and Efficient
High procedural success rates with low morbidity and mortality are demonstrated by early clinical data.
Extends Treatable Aneurysm Spectrum
The more recent 0.021″ microcatheter-compatible design increases patient applicability by enabling the treatment of smaller and farther-reaching aneurysms.
post-treatment recovery
Hospitalization and Observation
Because the treatment is minimally invasive, most patients have a brief hospital stay and are frequently released within 24 hours if they are stable.
Neurological Evaluation
To ensure neurological stability and identify any early issues, routine neurological tests are performed after the treatment.
Activity Suggestions
For one to two weeks, patients should refrain from heavy lifting and physically demanding tasks.
They should then gradually resume their regular activities as tolerated.
Medication Schedule
Since the device is intrasaccular and lacks major parent vessel coverage, short-term antiplatelet therapy (such as aspirin for four to six weeks) is usually advised instead of long-term dual antiplatelet therapy.
Imaging Follow-Up
To track the status of aneurysm occlusion and device position, imaging follow-up with angiography or MRI is carried out after three to six months and then again at twelve months.
Long-Term Results
With minimal retreatment rates and long-lasting aneurysm closure, the majority of patients have a good neurological recovery.
Rehabilitation
