{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T04:07:55Z","timestamp":1784088475719,"version":"3.55.0"},"reference-count":0,"publisher":"Annali Italiani di Chirurgia","issue":"7","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann. Ital. Chir."],"abstract":"<jats:p>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\u20132) 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.<\/jats:p>","DOI":"10.62713\/aic.4545","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T03:36:40Z","timestamp":1784086600000},"source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.62713","volume":"97","author":[{"given":"Heng","family":"Ni","sequence":"first","affiliation":[{"name":"Department of Neurology, Affiliated Hangzhou First People's Hospital, School of Medicine of Westlake University, 310006 Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Hangzhou First People's Hospital, School of Medicine of Westlake University, 310006 Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Congguo","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Hangzhou First People's Hospital, School of Medicine of Westlake University, 310006 Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenqing","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Hangzhou First People's Hospital, School of Medicine of Westlake University, 310006 Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linbo","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 210029 Nanjing, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Hangzhou First People's Hospital, School of Medicine of Westlake University, 310006 Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"48935","published-online":{"date-parts":[[2026,7,14]]},"container-title":["Annali Italiani di Chirurgia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.annaliitalianidichirurgia.it\/journal\/AIC\/97\/7\/10.62713\/aic.4545","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T03:36:41Z","timestamp":1784086601000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.annaliitalianidichirurgia.it\/journal\/AIC\/97\/7\/10.62713\/aic.4545"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":0,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026]]}},"alternative-id":["S0003-469X(26)00137-0"],"URL":"https:\/\/doi.org\/10.62713\/aic.4545","relation":{},"ISSN":["0003-469X","2239-253X"],"issn-type":[{"value":"0003-469X","type":"print"},{"value":"2239-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]},"article-number":"1300"}}