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Zhang L, Chen X, Dong L, Liu P, Jia L, Zhang Y, Lv M. Clinical and Angiographic Outcomes After Stent-Assisted Coiling of Cerebral Aneurysms With Laser-Cut and Braided Stents: A Comparative Analysis of the Literatures. Front Neurol 2021; 12:666481. [PMID: 33995263 PMCID: PMC8116799 DOI: 10.3389/fneur.2021.666481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Stent-assisted coiling (SAC) plays an important role in endovascular treatment of intracranial aneurysms (IAs). This comparative analysis examines the safety and efficacy of SAC in general and compares clinical and angiographic outcomes between laser-cut stents and braided stents. Methods: Relevant English-language studies were identified via a PubMed search for published articles regarding outcomes of SAC using laser-cut stents and braided stents published from 2015 to 2020. Data from 56 studies that met our inclusion criteria were pooled and statistically compared. Results: A total of 4,373 patients harboring with 4,540 IAs were included. Patients were divided into two groups on the basis of stent type: laser-cut stents (2,076 aneurysms in 1991 patients; mean follow-up, 12.99 months) and braided stents (2,464 aneurysms in 2382 patients; mean follow-up, 18.41 months). Overall, the rates of successful stent deployment, thromboembolic events, stent stenosis, periprocedural intracranial hemorrhage, permanent morbidity, mortality, and recanalization were 97.72, 4.72, 2.87, 1.51, 2.14, 1.16, and 6.06%, respectively. Laser-cut stents were associated with a significantly higher rate of successful deployment (p = 0.003) and significantly lower rate of periprocedural intracranial hemorrhage (p = 0.048). Braided stents were associated with a significantly lower rate of permanent morbidity (p = 0.015). Conclusion: SAC of IAs using laser-cut stents or braided stents was effective and safe. Rates of thromboembolic events, stent stenosis, mortality, and recanalization were comparable between the stent types. Braided stents were associated with lower permanent morbidity while laser-cut stents were associated with more favorable rates of successful deployment and periprocedural intracranial hemorrhage.
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Affiliation(s)
- Longhui Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Xiheng Chen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Linggen Dong
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Luqiong Jia
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
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Chen J, Li M, Zhu X, Chen Y, Zhang C, Shi W, Chen Q, Wang Y. Anterior Communicating Artery Aneurysms: Anatomical Considerations and Microsurgical Strategies. Front Neurol 2020; 11:1020. [PMID: 33013671 PMCID: PMC7509403 DOI: 10.3389/fneur.2020.01020] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/04/2020] [Indexed: 11/29/2022] Open
Abstract
Anterior communicating artery aneurysms account for 23–40% of ruptured intracranial aneurysms and 12–15% of unruptured aneurysms and are the most common intracranial ruptured or unruptured aneurysms. Because they have relatively complex anatomical structures and anatomical variations and are adjacent to important blood vessels and structures, in the process of microsurgical exposure of an Anterior communicating artery aneurysm, attention should be paid not only to the anatomical characteristics of the aneurysm itself but also to the adjacent important blood vessels and perforating arteries; therefore, both surgical clipping and endovascular embolization are serious challenges for neurosurgeons. No matter which treatment is chosen, it is necessary to determine the structure of the Anterior communicating artery and its perforating arteries as well as whether there is a fenestration deformity of the Anterior communicating artery and the relationship between bilateral A1-A2 before surgery. The shape and size of the aneurysm itself and its location relative to adjacent blood vessels also need to be considered to better complete the procedure, and this is especially true for microsurgical clipping. Clarifying the anatomy before surgery is helpful for better selecting the surgical approach and surgical side, which could affect the intraoperative exposure of the aneurysm and adjacent arteries, the surgical difficulty, the resection rate, and the postoperative complications. Therefore, starting with Anterior communicating artery aneurysms and their adjacent structures and variations, this paper reviews the latest progress in surgical treatment based on anatomic specificity as well as the most recent clinical studies.
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Affiliation(s)
- Junhui Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China
| | - Mingchang Li
- Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China
| | - Xun Zhu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Chen
- Department of Internal Medicine, Hexian Hospital of Traditional Chinese Medicine, Ma'anshan, China
| | - Chunlei Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenwen Shi
- Department of Internal Medicine, Hexian Hospital of Traditional Chinese Medicine, Ma'anshan, China
| | - Qianxue Chen
- Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China
| | - Yuhai Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
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Sirakov A, Bhogal P, Möhlenbruch M, Sirakov S. Endovascular treatment of patients with intracranial aneurysms: feasibility and successful employment of a new low profile visible intraluminal support (LVIS) EVO stent. Neuroradiol J 2020; 33:377-385. [PMID: 32692304 PMCID: PMC7482042 DOI: 10.1177/1971400920941402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND PURPOSE Low-profile self-expandable stents have increased the number of intracranial aneurysms treated by endovascular means. The new low-profile visible intraluminal support device LVIS EVO (Microvention), the successor of LVIS Jr, is a self-expandable and retrievable microstent system, designed for implantation into intracranial arteries with a diameter up to 2.0 mm. In this retrospective study we aimed to elucidate the technical feasibility and clinical safety of the novel LVIS EVO stent for stent-assisted coil embolisation of intracranial aneurysms. MATERIALS AND METHODS A single centre technical report of the first six consecutive cases of stent-assisted coil embolisation with the novel LVIS EVO stent for the treatment of unruptured or recanalised intracranial aneurysms. Records were made of basic demographics, aneurysmal characteristics, device properties and related technical details, adverse events, clinical outcomes and occlusion rates on available radiological follow-up. RESULTS Six LVIS EVO devices were successfully implanted in all subjects to treat a total number of six intracranial aneurysms. No device-related intraprocedural complications were seen. At early clinical follow-up six out of six (100%) patients had a modified Ranking score of 0-1. Early angiographic and cross-sectional radiological follow-up, available in five out of six (83.3%) of the patients confirmed unchanged aneurysmal occlusion rates. A minor, transitory neurological deficit was recorded in one of the six (16.6%) patients. Mortality was 0%. CONCLUSIONS Preliminary experience in this subset of our patients confirms a notably improved technical behaviour of the novel LVIS EVO stent system when compared to its ancestor LVIS Jr. The enhanced visibility of the stent and the refined delivery/retrieval capabilities of the stent further increase the safety margins of the devices profile, especially in cases of tortuous anatomy.
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Affiliation(s)
- Alexander Sirakov
- Radiology Department, University Hospital Saint Ivan Rilski, Bulgaria
| | - Pervinder Bhogal
- Interventional Neuroradiology Department, The Royal London Hospital, UK
| | | | - Stanimir Sirakov
- Radiology Department, University Hospital Saint Ivan Rilski, Bulgaria
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Poncyljusz W, Zwarzany Ł, Limanówka B, Zbroszczyk M, Banach M, Bereza S, Sagan L. Stent-Assisted Coiling of Unruptured MCA Aneurysms Using the LVIS Jr. Device: A Multicenter Registry. J Clin Med 2020; 9:jcm9103168. [PMID: 33007864 PMCID: PMC7601776 DOI: 10.3390/jcm9103168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/20/2020] [Accepted: 09/29/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose: The low-profile visualized intraluminal support junior (LVIS Jr.) is a new generation low-profile braided stent. Our aim was to evaluate the safety and efficacy of the LVIS Jr. in the stent-assisted coiling of unruptured middle cerebral artery (MCA) aneurysms. This was a multicenter retrospective study. Patient demographics, aneurysm characteristics, procedural details, complications, and the results of clinical and imaging follow-up were analyzed. Four centers participated in the study. A total of 162 consecutive patients with 162 unruptured MCA aneurysms were included for the analysis. The mean aneurysm size was 7.6 mm (range 2 to 37 mm) and 97.5% were wide-necked. Immediate postprocedural angiograms showed Raymond-Roy class 1 in 118 (72.8%), class 2 in 23 (14.2%), and class 3 in 21 patients (13%). Periprocedural complications occurred in 14 patients (8.6%). There were no procedure-related deaths. Follow-up imaging at 12–18 months post-procedure showed Raymond–Roy class 1 in 132 (81.5%), class 2 in 17 (10.5%), and class 3 in 13 patients (8%). There were 3 cases of in-stent stenosis (1.9%). All 162 patients had good clinical outcome (mRS score 0–2) at 90 days post-procedure. Stent-assisted coiling of unruptured MCA aneurysms with the LVIS Jr. stent is safe and effective, with high immediate and long-term total occlusion rates.
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Affiliation(s)
- Wojciech Poncyljusz
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland;
| | - Łukasz Zwarzany
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland;
- Correspondence:
| | - Bartosz Limanówka
- Department of Neurosurgery and Pediatric Neurosurgery, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (B.L.); (L.S.)
| | - Miłosz Zbroszczyk
- Department of Radiodiagnostic and Interventional Radiology, Silesian Medical University, Medyków 14, 40-772 Katowice, Poland;
| | - Mariusz Banach
- Department of Neurosurgery, Saint Raphael Hospital, Adama Bochenka 12, 30-693 Kraków, Poland;
| | - Sławomir Bereza
- Neurointerventional CathLab, Lower Silesian Specialist Tadeusz Marciniak Memorial Hospital—Emergency Medicine Center, Fieldorfa 2, 54-049 Wrocław, Poland;
| | - Leszek Sagan
- Department of Neurosurgery and Pediatric Neurosurgery, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (B.L.); (L.S.)
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Cagnazzo F, Cappucci M, Lefevre PH, Dargazanli C, Gascou G, Morganti R, Mazzotti V, di Carlo D, Perrini P, Mantilla D, Riquelme C, Bonafe A, Costalat V. Treatment of Intracranial Aneurysms with Self-Expandable Braided Stents: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2018; 39:2064-2069. [PMID: 30262643 DOI: 10.3174/ajnr.a5804] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/30/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND The safety and efficacy of treatment with self-expandable braided stents (LEO and LVIS) required further investigation. PURPOSE Our aim was to analyze the outcomes after treatment with braided stents. DATA SOURCES A systematic search of 3 databases was performed for studies published from 2006 to 2017. STUDY SELECTION According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting patients treated with LEO or LVIS stents. DATA ANALYSIS Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and neurologic outcomes. DATA SYNTHESIS Thirty-five studies evaluating 1426 patients treated with braided stents were included in this meta-analysis. Successful stent delivery and complete aneurysm occlusion were 97% (1041/1095; 95% CI, 95%-98%) (I2 = 44%) and 88.3% (1097/1256; 95% CI, 85%-91%) (I2 = 72%), respectively. Overall, treatment-related complications were 7.4% (107/1317; 95% CI, 5%-9%) (I2 = 44%). Ischemic/thromboembolic events (48/1324 = 2.4%; 95% CI, 1.5%-3.4%) (I2 = 27%) and in-stent thrombosis (35/1324 = 1.5%; 95% CI, 0.6%-1.7%) (I2 = 0%) were the most common complications. Treatment-related morbidity was 1.5% (30/1324; 95% CI, 0.9%-2%) and was comparable between the LEO and LVIS groups. Complication rates between the anterior (29/322 = 8.8%; 95% CI, 3.4%-12%) (I2 = 41%) versus posterior circulation (10/84 = 10.5%; 95% CI, 4%-16%) (I2 = 0%) and distal (30/303 = 8%; 95% CI, 4.5%-12%) (I2 = 48%) versus proximal aneurysms (14/153 = 9%; 95% CI, 3%-13%) (I2 = 46%) were comparable (P > .05). LIMITATIONS Limitations were selection and publication biases. CONCLUSIONS In this analysis, treatment with the LEO and LVIS stents was relatively safe and effective. The most common complications were periprocedural thromboembolisms and in-stent thrombosis. The rate of complications was comparable among anterior and posterior circulation aneurysms, as well as for proximal and distally located lesions.
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Affiliation(s)
- F Cagnazzo
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - M Cappucci
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - P-H Lefevre
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - C Dargazanli
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - G Gascou
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - R Morganti
- Section of Statistics (R.M., V.M.), University Hospital of Pisa, Pisa, Italy
| | - V Mazzotti
- Section of Statistics (R.M., V.M.), University Hospital of Pisa, Pisa, Italy
| | - D di Carlo
- Department of Neurosurgery (D.d.C., P.P.), University of Pisa, Pisa, Italy
| | - P Perrini
- Department of Neurosurgery (D.d.C., P.P.), University of Pisa, Pisa, Italy
| | - D Mantilla
- Neuroradiology Department (D.M.), Clinic FOSCAL, Universidad Autonoma de Bucaramanga, Andrés Bello National University, Santiago, Chili
| | - C Riquelme
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - A Bonafe
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - V Costalat
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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Mine B, Bonnet T, Vazquez-Suarez JC, Iosif C, Lubicz B. Comparison of stents used for endovascular treatment of intracranial aneurysms. Expert Rev Med Devices 2018; 15:793-805. [DOI: 10.1080/17434440.2018.1538779] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Benjamin Mine
- Department of Interventional Neuroradiology, University Hospital Erasme, Brussels, Belgium
| | - Thomas Bonnet
- Department of Interventional Neuroradiology, University Hospital Erasme, Brussels, Belgium
| | | | - Christina Iosif
- Department of Interventional Neuroradiology, University Hospital Erasme, Brussels, Belgium
| | - Boris Lubicz
- Department of Interventional Neuroradiology, University Hospital Erasme, Brussels, Belgium
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Santillan A, Schwarz J, Boddu S, Gobin YP, Knopman J, Patsalides A. Stent-assisted coil embolization of anterior communicating artery aneurysms using the LVIS Jr stent. Interv Neuroradiol 2018; 25:12-20. [PMID: 30180758 DOI: 10.1177/1591019918798144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND PURPOSE This retrospective study evaluates the safety and mid-term and long-term effectiveness of stent-assisted coil embolization of anterior communicating artery (Acomm) aneurysms treated with the LVIS Jr stent. MATERIALS AND METHODS All patients treated with the LVIS Jr stent for Acomm aneurysms between June 2015 and March 2018 were included in the analysis. Details of the procedure's periprocedural adverse events, immediate aneurysm occlusion rates, and clinical and angiographic follow-up assessment were collected. RESULTS A total of 25 patients with 25 aneurysms were included. Eighteen aneurysms were found incidentally. Seven patients presented with seven ruptured aneurysms: Six were remotely ruptured and one acutely ruptured. Twenty-four patients were treated successfully and one technical failure is reported. The parent arteries measured 1.4 mm to 2.9 mm in diameter (mean, 2.3 mm). Intraprocedural thromboembolic complications occurred in two patients (8%) and an intraoperative aneurysm rupture in one patient (4%). Immediate complete aneurysm occlusion was noted in 18 out of 25 patients (72%). Clinical follow-up ranged from three months to 36 months (mean, 15.8 months) and the imaging follow-up ranged from two to 35 months (mean, 14.2 months). Complete aneurysm occlusion was achieved in 14 out of 20 patients (70%) at last angiographic follow-up. Of the two patients with in-stent thrombosis, one patient had an acutely ruptured aneurysm and the other patient was treated with an LVIS Jr stent in a Y configuration. Neurological morbidity and mortality rate were 0%. CONCLUSIONS Complex, wide-necked Acomm aneurysms can be effectively treated with stent-assisted embolization using LVIS Jr stents.
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Affiliation(s)
- Alejandro Santillan
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
| | - Justin Schwarz
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
| | - Srikanth Boddu
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
| | - Y Pierre Gobin
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
| | - Jared Knopman
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
| | - Athos Patsalides
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
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Choi HH, Cho YD, Yoo DH, Ahn SJ, Cho WS, Kang HS, Kim JE, Lee JJ, Moon JH, Han MH. Stent-assisted coil embolization of anterior communicating artery aneurysms: safety, effectiveness, and risk factors for procedural complications or recanalization. J Neurointerv Surg 2018; 11:49-56. [PMID: 29871991 DOI: 10.1136/neurintsurg-2018-013943] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Stent-assisted coil (SAC) embolization is an alternative treatment option for anterior communicating artery (AcoA) aneurysms. This study was undertaken to assess the safety and effectiveness of SAC embolization in treating AcoA aneurysms and to determine risk factors for related procedural complications or recanalization. METHODS Between August 2008 and December 2016, 184 patients with AcoA aneurysms were treated with SAC embolization. Cumulative medical record and radiologic data were analyzed using binary logistic regression to identify factors predisposing to procedural complications or recanalization. RESULTS Contralateral A1 segment hypoplasia was observed in 59 patients (32.1%). Three types of stents (LVIS, Enterprise, and Neuroform) were variably placed by one of two routes: (1) ipsilateral A1 to ipsilateral A2 (75.5%) or (2) ipsilateral A1 to contralateral A2 (24.5%). Procedural complications occurred in 17 patients (thromboembolism 12; procedural leakage 3; both 2), showing a significant relation to subarachnoid hemorrhage at presentation (OR 57.750; P<0.01). Occlusion was documented immediately after embolization in 130 aneurysms (70.6%) and, in 23 (13.1%) of 175 AcoA aneurysms followed by angiography (median 25.9±18.5 months), recanalization developed (minor, 15; major, 8). Stent configuration (ipsilateral A1 to contralateral A2, P=0.024), maximum aneurysm size (>7 mm, P<0.01), and A1 segment hypoplasia (P=0.039) were identified as risk factors for recanalization. CONCLUSION SAC embolization is a safe and effective method of treating unruptured AcoA aneurysms, regardless of anatomic or clinical features. However, in the event of rupture, procedural complications are likely. Stent configuration, aneurysm size, and A1 segment hypoplasia were identified as significant risk factors for recanalization.
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Affiliation(s)
- Hyun Ho Choi
- Department of Neurosurgery, Chung-ang University Hospital, Chung-ang University College of Medicine, Seoul, The Republic of Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, The Republic of Korea
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, The Republic of Korea
| | - Sang Jun Ahn
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, The Republic of Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, The Republic of Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, The Republic of Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, The Republic of Korea
| | - Jeong Jun Lee
- Department of Neurosurgery, Dongguk University Hospital, Dongguk University College of Medicine, Ilsan, The Republic of Korea
| | - Jong Hyun Moon
- Department of Neurosurgery, Gwangju Christian Hospital, Gwangju, The Republic of Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, The Republic of Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, The Republic of Korea
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Yan Y, Zhu D, Tang H, Huang Q. Safety and Efficacy of Flow Diverter Treatment for Aneurysm in Small Cerebral Vessels: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 115:54-64. [PMID: 29653275 DOI: 10.1016/j.wneu.2018.04.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/01/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To clarify the safety and efficacy of flow diverter (FD) treatment for aneurysm in small cerebral vessels, we conducted a systematic review of the literature analyzing perioperative and long-term clinical and angiographic outcomes. METHODS A comprehensive review of the up-to-date literature for studies with ≥10 patients related to FD treatment of small vessel aneurysms published was performed. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical procedural success, perioperative mortality, perioperative stroke, procedure-related morbidity and mortality, all complications, long-term mortality, and overall good outcome. RESULTS We included 26 noncomparative studies with 572 target aneurysms. The technical procedural success rate was 96% (95% confidence interval [CI] 0.93-1.00). At final follow-up, the complete occlusion rate was 70% (95% CI 0.64-0.76). The all-cause morbidity rate was 20% (95% CI 0.14-0.25). Procedure-related morbidity and mortality rates were 9% (95% CI 0.07-0.12) and 4% (95% CI 0.00-0.08), respectively. Overall long-term good outcome rate was 96% (95% CI 0.93-0.99). In the 3 subgroup analyses, complete occlusion rate of saccular aneurysms was lower than that of nonsaccular aneurysms (55% vs. 73%, respectively; odds ratio 0.40, 95% CI 0.17-0.98, P = 0.04). The procedure-related morbidity rate and the good outcome rate were not significantly different in this subgroup. In the other 2 subgroups in which we compared anterior circulation aneurysms with posterior circulation aneurysms and single FD strategy with overlapped FD strategy, the rates were also not significantly different. CONCLUSIONS Our meta-analysis demonstrated that FD treatment of small vessel aneurysms is technically feasible and effective with a high rate of complete occlusion. Although the comorbidities of patients cannot be neglected, the FD approach was associated with an acceptable rate of procedure-related morbidity and a satisfactory rate of overall good outcome.
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10
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Santillan A, Boddu S, Schwarz J, Lin N, Gobin YP, Knopman J, Patsalides A. LVIS Jr. stent for treatment of intracranial aneurysms with parent vessel diameter of 2.5 mm or less. Interv Neuroradiol 2018; 24:246-253. [PMID: 29463145 DOI: 10.1177/1591019918759307] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and purpose This retrospective study evaluates the safety, effectiveness, and long-term clinical and angiographic follow-up of intracranial aneurysms treated with the Low-Profile Visualized Intraluminal Support Junior (LVIS Jr.) stent and parent vessels of diameter equal to or less than 2.5 mm. Materials and methods We included all patients treated with the LVIS Jr. stent in aneurysms with small parent vessel diameter between March 2015 and July 2017. Periprocedural adverse events, immediate aneurysm occlusion rates, and clinical and angiographic follow-up are reported. Results A total of 35 patients with 35 aneurysms were included. Ten aneurysms were ruptured (28.6%) and 25 were unruptured (71.4%). The parent arteries measured 0.9 mm to 2.5 mm in diameter (mean, 2.2 mm). Intra-procedural thromboembolic complications occurred in four patients (11.4%) and there was an intraoperative aneurysm rupture in one patient (2.8%). Immediate complete aneurysm occlusion was noted in 21 out of 35 patients (60%). Clinical follow-up ranged between one and 25 months (mean, 10.5 months) and magnetic resonance angiography follow-up ranged between four and 24 months (mean, 10.4 months). Complete aneurysm occlusion was achieved in 21 out of 29 patients (72.4%) at last angiographic follow-up (mean, 9.4 months; range four to 23 months). In-stent stenosis occurred in one out of 29 patients (3.4%), who was asymptomatic. Of the four patients with in-stent thrombosis, three patients were treated with "Y configuration" (two patients with middle cerebral artery aneurysms and one patient with an anterior communicating artery aneurysm). Mortality rate was 0%. Neurological morbidity was 2.9%. Conclusions Stenting with the LVIS Jr. stent allowed us to treat complex intracranial aneurysms with parent vessel diameter of 2.5 mm or less with an acceptable safety profile.
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Affiliation(s)
- Alejandro Santillan
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York, USA
| | - Srikanth Boddu
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York, USA
| | - Justin Schwarz
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York, USA
| | - Ning Lin
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York, USA
| | - Y Pierre Gobin
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York, USA
| | - Jared Knopman
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York, USA
| | - Athos Patsalides
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York, USA
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Cheung NK, Chiu AHY, Cheung AK, Wenderoth JD. Long-term follow-up of aneurysms treated electively with woven stent-assisted coiling. J Neurointerv Surg 2017; 10:669-674. [DOI: 10.1136/neurintsurg-2017-013402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/02/2017] [Accepted: 11/03/2017] [Indexed: 11/03/2022]
Abstract
BackgroundPreliminary short-term results for stent-assisted coil embolization (SACE) using woven/braided stents have been promising. However, evidence supporting mid- to long-term efficacy and durability is lacking.ObjectiveTo report the long-term results for the durability of elective intracranial aneurysms treated with woven stents.Materials and methodsBetween May 2012 and May 2015, 98 consecutive patients with 103 aneurysms underwent elective woven SACE across three Australian neurovascular centres. All patients had immediate, 6- and 18-month clinical and radiological follow-up. Radiological assessment was performed with modified Raymond–Roy occlusion scores based on angiography results, while clinical assessment was based on the modified Rankin Scale.ResultsSix-month follow-up was available in 100 aneurysms, and an 18-month follow-up in 97 aneurysms. Total occlusion rates of 82% were achieved at inception, 82% at 6 months, and 90% at 18 months. Satisfactory occlusion with small neck remnants was present in 17% at inception, 16% at 6 months, and 9% at 18 months. Good neurological outcomes were achieved in 95% at 18 months. Intraprocedural thromboembolic events were recorded in 3% and delayed events in 1% (all in patients taking clopidogrel). Aneurysm recurrence occurred in one patient (1%). Technical complications occurred in 5%. The total complication rate was 10%.ConclusionsWoven SACE is safe, efficacious, and durable at long-term 18-month follow-up, with very low recurrence and re-treatment rates. Preliminary results appear better than those for traditional laser-cut stents.
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12
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Iosif C, Piotin M, Saleme S, Barreau X, Sedat J, Chau Y, Sourour N, Aggour M, Brunel H, Bonafe A, Machi P, Riquelme C, Costalat V, Pierot L, Blanc R, Mounayer C. Safety and effectiveness of the Low Profile Visualized Intraluminal Support (LVIS and LVIS Jr) devices in the endovascular treatment of intracranial aneurysms: results of the TRAIL multicenter observational study. J Neurointerv Surg 2017; 10:675-681. [PMID: 29175829 PMCID: PMC6031274 DOI: 10.1136/neurintsurg-2017-013375] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/30/2017] [Accepted: 11/02/2017] [Indexed: 12/02/2022]
Abstract
Background and purpose To evaluate the safety and effectiveness of the low-profile braided intracranial stents called the Low Profile Visualized Intraluminal Support (LVIS) devices for stent-assisted coil embolization of wide-necked intracranial aneurysms. Materials and methods This was a prospective, multicenter, observational study of unruptured and ruptured intracranial aneurysms treated with the LVIS devices. Imaging and clinical data were independently analyzed respectively by CoreLab and Clinical Event Committee. Primary endpoints were clinical safety, effectiveness, and angiographic stability of the results at 6 and 18 months. Results Ten centers participated in the study; 102 patients were included and 90 patients (42.2% men, 57.8% women) were eventually analyzed, among which 27 (30.0%) had multiple aneurysms. Twenty-three (25.6%) were ruptured aneurysms, four of which (4.4%) were treated in the acute phase. One aneurysm was treated per patient; 92 LVIS and LVIS Jr devices were placed overall. The total aneurysm occlusion rate was 91.0% on immediate post-procedure angiograms, which remained unchanged at 6-month follow-up and was 92.4% at 18-month follow-up. One patient (1.1%) underwent retreatment between 6 and 18 months of follow-up. A modified Rankin score of 0 was documented for most cases immediately after the procedure (86.7%) and at 6-month (86.8%) and 18-month (83.3%) follow-up. The overall permanent morbidity rate at 18 months was 5.6% and the overall rate of events with sequelae related to the stent was 2.2%. The 18-month procedure-related mortality rate was 3.3%. No patient was deemed to require retreatment at 18-month follow-up. Conclusion The LVIS/LVIS Jr endovascular devices are safe and effective in the treatment of ruptured and unruptured intracranial aneurysms, with acceptable complication rates, very high immediate total occlusion rates, and stable angiographic results.
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Affiliation(s)
- Christina Iosif
- Department of Interventional Neuroradiology, CHU-Limoges Dupuytren University Hospital, Limoges, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Foundation Rothschild Hospital, Limoges, France
| | - Suzana Saleme
- Department of Interventional Neuroradiology, CHU-Limoges Dupuytren University Hospital, Limoges, France
| | - Xavier Barreau
- Department of Interventional Neuroradiology, CHU Pellegrin, Paris, France
| | - Jacques Sedat
- Department of Interventional Neuroradiology, Hôpital Saint-Roch, Nice, France
| | - Yves Chau
- Department of Interventional Neuroradiology, Hôpital Saint-Roch, Nice, France
| | - Nader Sourour
- Department of Interventional Neuroradiology, La Pitié-Salpétrière, Paris, France
| | - Mohamed Aggour
- Department of Interventional Neuroradiology, Hôpital Bellevue, Saint-Etienne, France
| | - Herve Brunel
- Department of Interventional Neuroradiology, Hôpital de la Timone, Marseille, France
| | - Alain Bonafe
- Department of Interventional Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Paolo Machi
- Department of Interventional Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Carlos Riquelme
- Department of Interventional Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Vincent Costalat
- Department of Interventional Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Laurent Pierot
- Department of Interventional Neuroradiology, Hôpital Maison Blanche, Reims, France
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Foundation Rothschild Hospital, Limoges, France
| | - Charbel Mounayer
- Department of Interventional Neuroradiology, CHU-Limoges Dupuytren University Hospital, Limoges, France
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Park SY, Oh JS, Oh HJ, Yoon SM, Bae HG. Safety and Efficacy of Low-Profile, Self-Expandable Stents for Treatment of Intracranial Aneurysms: Initial and Midterm Results - A Systematic Review and Meta-Analysis. INTERVENTIONAL NEUROLOGY 2017; 6:170-182. [PMID: 29118794 DOI: 10.1159/000471890] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Low-profile stents seem to be associated with a higher incidence of thromboembolic events compared with preexisting stents. We conducted a systematic review of 11 eligible reports and a meta-analysis of 7 reports with respect to the clinical efficacy and safety of low-profile stents. There were 217 intracranial aneurysms reported; 22% were ruptured aneurysms. In all, 72% were treated using single stenting, 19% were treated using overlapping stenting, and 6% were treated using balloon angioplasty followed by stenting; 3% were used to assess the flow diverter effect in a dissecting aneurysm or were treated using unexpected subtotal coil packing. On immediate postprocedural angiographic results, Raymond class I and II obliteration was obtained in 87% of the aneurysms. On angiographic results at 3-6 months, Raymond class I and II obliteration or stability was obtained in 79% of the aneurysms, and Raymond class III obliteration was obtained in 3% of the aneurysms. The recurrence rate on follow-up of intracranial aneurysms was 6.5% (5.7% with LEO Baby and 1.3% with LVIS Jr). The periprocedural complication rate was 12.4%. Periprocedural thromboembolism occurred in 6.5% of the cases. The rate of in-stent stenosis on follow-up of intracranial aneurysms was 10%. In the midterm result, the recurrence rate with use of low-profile, self-expandable stents was relatively low compared to that with use of other self-expandable stents. In the meta-analysis comparing LEO Baby with LVIS Jr, the obliteration rate at 6 months was not significantly different, but the periprocedural complication rate was relatively low with LVIS Jr.
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Affiliation(s)
- Su-Yeon Park
- Department of Statistics, Soonchunhyang University Hospital Cheonan, Cheonan, Republic of Korea
| | - Jae-Sang Oh
- Department of Neurosurgery, Soonchunhyang University Hospital Cheonan, Cheonan, Republic of Korea
| | - Hyuk-Jin Oh
- Department of Neurosurgery, Soonchunhyang University Hospital Cheonan, Cheonan, Republic of Korea
| | - Seok-Mann Yoon
- Department of Neurosurgery, Soonchunhyang University Hospital Cheonan, Cheonan, Republic of Korea
| | - Hack-Gun Bae
- Department of Neurosurgery, Soonchunhyang University Hospital Cheonan, Cheonan, Republic of Korea
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14
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Gupta M, Cheung VJ, Abraham P, Wali AR, Santiago-Dieppa DR, Gabel BC, Almansouri A, Pannell JS, Khalessi AA. Low-profile Visualized Intraluminal Support Junior Device for the Treatment of Intracranial Aneurysms. Cureus 2017; 9:e1037. [PMID: 28357169 PMCID: PMC5356986 DOI: 10.7759/cureus.1037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: Early case series suggest that the recently introduced Low-profile Visualized Intraluminal Support Junior (LVIS Jr.) device (MicroVention-Terumo, Inc., Tustin, CA) may be used to treat wide-necked aneurysms that would otherwise require treatment with intrasaccular devices or open surgery. We report our single-center experience utilizing LVIS Jr. to treat intracranial aneurysms involving 1.8-2.5 mm parent arteries. Methods: We retrospectively reviewed records of patients treated with the LVIS Jr. device for intracranial aneurysms at a single center. A total of 21 aneurysms were treated in 18 patients. Aneurysms were 2-25 mm in diameter; one was ruptured, while three had recurred after previous rupture and treatment. Lesions were distributed across the anterior (n=12) and posterior (n=9) circulations. Three were fusiform morphology. Results: Stent deployment was successful in 100% of cases with no immediate complications. Seventeen aneurysms were treated with stent-assisted coil embolization resulting in immediate complete occlusion in 94% of cases. Two fusiform aneurysms arising from the posterior circulation were further treated with elective clip ligation after delayed expansion and recurrence; no lesions required further endovascular treatment. Four aneurysms were treated by flow diversion with stand-alone LVIS Jr. stent, and complete occlusion was achieved in three cases. Small foci of delayed ischemic injury were noted in two patients in the setting of antiplatelet medication noncompliance. No in-stent stenosis, migration, hemorrhage, or permanent deficits were observed. Good functional outcome based on the modified Rankin Scale score (mRS ≤ 2) was achieved in 100% of cases. Conclusion: Our midterm results suggest that the LVIS Jr. stent may be used for a variety of intracranial aneurysms involving small parent arteries (1.8-2.5 mm) with complete angiographic occlusion, parent vessel preservation, and functional clinical outcomes. This off-label expansion would increase the number of aneurysms amenable to endovascular treatment. Future studies may build upon our experiences with flow diversion and treatment of complex or multiple lesions.
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Affiliation(s)
- Mihir Gupta
- Department of Neurosurgery, University of California, San Diego
| | | | - Peter Abraham
- Department of Neurosurgery, University of California, San Diego
| | - Arvin R Wali
- Department of Neurosurgery, University of California, San Diego
| | | | - Brandon C Gabel
- Department of Neurosurgery, University of California, San Diego
| | | | - J Scott Pannell
- Department of Neurosurgery, University of California, San Diego
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15
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Grossberg JA, Hanel RA, Dabus G, Keigher K, Haussen DC, Sauvageau E, Linfante I, Gonsales D, Aguilar Salinas P, Bouslama M, Mayich M, Nogueira RG, Lopes DK. Treatment of wide-necked aneurysms with the Low-profile Visualized Intraluminal Support (LVIS Jr) device: a multicenter experience. J Neurointerv Surg 2016; 9:1098-1102. [PMID: 27789790 DOI: 10.1136/neurintsurg-2016-012687] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Low-profile Visualized Intraluminal Support (LVIS) Junior stent is newly approved for the treatment of wide-necked intracranial aneurysms. OBJECTIVE To report our multicenter experience with use of the LVIS Jr device. METHODS The neurointerventional databases of the participating institutions were retrospectively reviewed for aneurysms treated with LVIS Jr from the time of Food and Drug Administration approval until February 2016. All patients in the study period were included. Clinical presentation, aneurysm location, aneurysm size, vessel size, procedural complications, clinical and imaging follow-up were included in the analysis. RESULTS Eighty-five patients (54 female and 31 male) met the inclusion criteria for the study. Sixty-eight (80%) of the aneurysms were unruptured and the remainder were ruptured. The most common location of the treated aneurysms was anterior communicating artery (36%), middle cerebral artery bifurcation (22%), and basilar terminus (15%). The mean aneurysm size was 6.1 mm. The mean minimum parent vessel size was 2.3 mm. The LVIS Jr was successfully deployed in all but one case (99%). Initial angiographic results demonstrated Roy-Raymond class 1-2 occlusions in 61/84 patients (73%). At 6 months, 85% of the patients seen at follow-up had Roy-Raymond class 1-2 aneurysm occlusion. No procedure-related deaths occurred. Two cases of procedure-related complications (intraprocedural rupture and delayed rupture at day 2) were seen, leading to permanent neurologic morbidity. Both these cases were in patients with ruptured aneurysms. CONCLUSIONS The LVIS Jr is a technically feasible, safe, and effective treatment for wide-necked intracranial aneurysms. Early results are promising but will need to be corroborated with longer-term follow-up.
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Affiliation(s)
- J A Grossberg
- Emory University/Grady Memorial Hospital, Atlanta, Georgia, USA
| | - R A Hanel
- Baptist Neurological Institute, Jacksonville, Florida, USA
| | - G Dabus
- Department of NeuroInterventional Surgery, Miami Cardiac & Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
| | - K Keigher
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - D C Haussen
- Emory University/Grady Memorial Hospital, Atlanta, Georgia, USA
| | - E Sauvageau
- Baptist Neurological Institute, Jacksonville, Florida, USA
| | - I Linfante
- Department of NeuroInterventional Surgery, Miami Cardiac & Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
| | - D Gonsales
- Baptist Neurological Institute, Jacksonville, Florida, USA
| | | | - M Bouslama
- Emory University/Grady Memorial Hospital, Atlanta, Georgia, USA
| | - M Mayich
- Department of NeuroInterventional Surgery, Miami Cardiac & Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
| | - R G Nogueira
- Emory University/Grady Memorial Hospital, Atlanta, Georgia, USA
| | - D K Lopes
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
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16
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Zhang X, Zhong J, Gao H, Xu F, Bambakidis NC. Endovascular treatment of intracranial aneurysms with the LVIS device: a systematic review. J Neurointerv Surg 2016; 9:553-557. [PMID: 27206450 DOI: 10.1136/neurintsurg-2016-012403] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Despite promising initial results, current knowledge regarding the use of the Low-profile Visualized Intraluminal Support (LVIS) device to treat wide-necked intracranial aneurysms is still limited. Our aim is to evaluate the feasibility, efficacy, and safety of the LVIS device in stent-assisted coiling of intracranial aneurysms. METHODS We conducted a systematic review by searching PubMed, EMBASE, and Cochrane Library for all published studies on the treatment of intracranial aneurysms with the LVIS device up to March 2016. Feasibility was evaluated by the technical success rate during the procedure, efficacy was evaluated by the rate of complete aneurysm occlusion at follow-up angiography, and safety was assessed by procedure-related morbidity and mortality. RESULTS A total of nine studies were included in the analysis, including 384 patients with 390 aneurysms. The overall technical success rate was 96.8% (95% CI 94.4% to 99.1%). The aneurysmal complete occlusion rate was 54.6% (95% CI 31.8% to 77.4%) on immediate control and 84.3% (95% CI 78.9% to 89.7%) at follow-up angiography. Procedural-related morbidity and mortality were 1.4% (95% CI 0.2% to 2.6%) and 0% (95% CI 0%), respectively. The thromboembolic event rate was 4.9% (95% CI 1.9% to 7.9%) and the hemorrhagic event rate was 2.1% (95% CI 0.7% to 3.5%), with 0.9% (95% CI 0% to 1.8%) experiencing neurologic hemorrhagic complications and 1.9% (95% CI 0.5% to 3.2%) experiencing non-neurologic hemorrhagic complications. CONCLUSIONS Our systematic review suggests that endovascular treatment of intracranial aneurysms with the LVIS device is feasible, safe, and effective in the short term. However, the rate of thromboembolic complications is not negligible. Further prospective studies are needed to evaluate the long-term efficacy and safety of the LVIS device.
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Affiliation(s)
- Xiaoguang Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Henan University, Henan, China
| | - Junjie Zhong
- Department of Neurosurgery, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Heng Gao
- Department of Neurosurgery, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Feng Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Nicholas C Bambakidis
- Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
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17
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Feng Z, Fang Y, Xu Y, Hong B, Zhao W, Liu J, Huang Q. The safety and efficacy of low profile visualized intraluminal support (LVIS) stents in assisting coil embolization of intracranial saccular aneurysms: a single center experience. J Neurointerv Surg 2016; 8:1192-1196. [PMID: 26747876 DOI: 10.1136/neurintsurg-2015-012090] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 12/14/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The low profile visualized intraluminal support (LVIS) device is a new generation of self-expanding braided stents recently introduced into China for stent assisted coiling of intracranial aneurysms. This study assessed the clinical safety and efficacy of the LVIS stent for embolization of intracranial saccular aneurysms. METHODS Patients with intracranial saccular aneurysms treated using the LVIS device in our center between April 2014 and December 2014 were reviewed. The primary outcomes were procedural safety, target aneurysm recurrence, and mid-term follow-up of clinical and angiographic outcomes. RESULTS 97 patients with intracranial saccular aneurysms were treated using the LVIS stent, with 100% technical success rate. No mortality was observed. One patient had transient deficit (1/97, 1.0%). Immediate angiographic outcome evaluation showed complete occlusion in 28 (28.8%) and neck remnant in 39 (40.2%) of the 97 patients, respectively. Of the 76 (78.35%) patients who underwent angiographic follow-up at a mean of 8.1 months, complete occlusion was achieved in 64 (84.2%) patients. In the remaining patients, neck remnant in nine (11.8%) and residual sac in three (4%) patients were observed. None of the patients had any target aneurysm recurrence, and the mortality rate was 0%. CONCLUSIONS The LVIS stent is safe and effective in the treatment of intracranial saccular aneurysms.
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Affiliation(s)
- Zhengzhe Feng
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yibin Fang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yi Xu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Bo Hong
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wenyuan Zhao
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
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