Endovascular Treatment of Tiny Aneurysms With Low-Profile Visualized Intraluminal Support Devices Using a “Compressed” Stent Technique

Zhou, Yangyang; Peng, Qichen; Wu, Xiaoxuan; Zhang, Yisen; Liu, Jian; Yang, Xinjian; Mu, Shiqing

doi:10.3389/fneur.2020.610126

Cited by 4 publications

(6 citation statements)

References 27 publications

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“…The SBT has been described using various terms in the literature, such as the "shelf technique," "barrel technique," "stent bulging," "compressed stent," "intentional stent herniation," "intentional shortening," "compaction," or "wrapped-candy" techniques. 8,11,12,[15][16][17][18][19] Although some authors prefer to use the term "compression/compaction" for all types of aneurysms, on the basis of our review of the relevant literature, we think that the terms "compression," "compaction," "shortening," and "wrapped-candy" should be reserved for sidewall aneurysms, whereas "shelf," "herniation," or "bulging" should be used for bifurcation aneurysms. Technically, the maneuvers performed to achieve a compacted stent are similar in both scenarios; however, the intent (the ability to preserve a side branch versus the desire to achieve a better flow diversion) and the immediate angiographic results (bulged stent versus shortened stent) are different.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11] The proponents of this technique suggest that the rate of aneurysm occlusion increases, without a risk of increased complications, due to the enhancement of the flow diversion by the increased metallic coverage (compaction) at the aneurysm neck. 12,19 To date, the studies on SBT have been limited to retrospective, small-scale, single-arm case series that have evaluated the safety and efficacy of the technique. 11 In addition, most publications about SBT relate to a single type of braided stent (LVIS family of stents; MicroVention).…”

Section: Discussionmentioning

confidence: 99%

“…1 Some authors have further suggested that the added flow diversion secondary to compaction is also observed in bifurcation aneurysms. [9][10][11][12] The aim of this study was to evaluate the utility of the SBT in bifurcation aneurysms by comparing the clinical and imaging outcomes of bifurcation aneurysms that are treated using a single type of stent, the classic SAC versus the SAC with SBT.…”

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confidence: 99%

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Effect of the Shelving Technique on the Outcome of Embolization in Intracranial Bifurcation Aneurysms

Çay

Arat

2022

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Stent bulging technique has been introduced as a technique that improves the outcome of aneurysm coiling. Our aim was to evaluate the utility of this technique, which involves the intentional herniation of stents into the bifurcation aneurysms during coiling.MATERIALS AND METHODS: Unruptured bifurcation aneurysms treated by stent-assisted coiling using a single type of low-profile braided (LEO Baby) stent between November 2012 and October 2018 were retrospectively evaluated. The clinical (age and sex) and morphologic characteristics (aneurysm size, neck size, proximal/distal diameters of the stented artery, incorporation of the origins of the side branches to the aneurysm neck, and bifurcation angle) and response to antiplatelet therapy were evaluated.RESULTS: Sixty-one patients (29 men, 47.5%; mean age, 55. 95 [SD, 12.33] years) with 66 aneurysms were included. There were 36 aneurysms in group A (treated with the stent bulging technique) and 30 aneurysms in group B (treated by classic stent-assisted coiling). There was no significant difference in the patient and aneurysm characteristics in the groups except for the larger size and wider neck of the aneurysms in group A (P ¼ .02 and P ¼ .04, respectively). At the mean follow-up of 27.30 (SD, 17.45) months, there was no significant difference in the complication rate, the occlusion status, and the early and long-term occlusion rates between the groups. The stent bulging technique did not predict total occlusion (Raymond-Roy I) at the final imaging follow-up. CONCLUSIONS:The stent bulging technique enables the coiling of larger, wide-neck aneurysms; however, we did not observe an added flow-diversion effect with the stent bulging technique compared with conventional stent-assisted coiling. We, therefore, suggest that bifurcation aneurysms should be coiled as densely and as safely as possible using this technique.ABBREVIATIONS: ACA ¼ anterior cerebral artery; RDPD ¼ regional diameter percentage difference; RR ¼ Raymond-Roy score; SAC ¼ stent-assisted coiling; SBT ¼ stent bulging technique; SCA ¼ superior cerebellar artery S tent-assisted coiling (SAC) is a safe and effective option in the treatment of wide-neck intracranial aneurysms. The stent provides a scaffold for the neointima formation and prevents coil protrusion into the parent artery. In addition, intracranial stents may result in the development of hemodynamic changes inside the aneurysm, which may lead to further aneurysm occlusion. These hemodynamic changes relate to the type (braided versus laser-cut stents), the number of stents, and the technique of stent deployment. 1,2 In some patients, SAC with a single stent may not provide sufficient neck coverage, and in these cases, dual stent placement in an X or Y configuration may be necessary. Dual stent placement is technically more challenging than basic SAC and is known to be associated with an increased rate of thromboembolic complications. [3][4][5][6] The stent bulging technique (SBT, also known as the shelf technique) has bee...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Effect of the Shelving Technique on the Outcome of Embolization in Intracranial Bifurcation Aneurysms

Çay

Arat

2022

AJNR Am J Neuroradiol

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“…This is particularly advantageous in small, distal and often tortuous vessels; and in the treatment of very small aneurysms. 22 Added markers at the flared ends of the stent, and increased number of radiopaque wires within the stent body improves visibility. The widely adopted “C” generation of device offers more radial force, imparting higher technical success rates for deployment.…”

Section: Discussionmentioning

confidence: 99%

Long term safety and effectiveness of LVIS Jr for treatment of intracranial aneurysms- a Canadian Multicenter registry

et al. 2022

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Background The Low-profile Visible Intraluminal Support device (LVIS Jr) has become a commonly used intracranial stent for the treatment of intracranial aneurysms. However long-term stability and effectiveness remains to be seen. The purpose of the study was to assess the long-term efficacy, safety and durability of LVIS Jr. in a retrospective multicenter registry. Methods Patients with saccular aneurysms treated at centers across Canada using LVIS Jr for intracranial aneurysms were included in this retrospective registry between the dates of January 2013 and April 2019. Self reported outcomes were collected and used to assess both perioperative and long term safety and effectiveness. Both univariate and multivariate analysis were performed. Results Total of 196 patients (132 Women; mean age of 57.6 years) underwent endovascular aneurysm treatment with at least 1 LVIS Jr. stent. Mean aneurysm dome size was 7.4 mm, and mean neck size of 4.3 mm. Mean clinical and imaging follow up were 950 and 899 days respectively. Class I/II was achieved in 85% on long term follow up. Periprocedural morbidity and mortality was 4.6% and 2% and additional delayed morbidity and mortality was 3% and 2.5%. Aneurysm size >10 mm was independent predictor of periprocedural complication (OR 2.59, p = 0.048) while an increased dome to neck ratio >1.5 was independent predictor of increased delayed complications (OR 3.99, p = 0.02). Conclusion The LVIS Jr. intracranial stent is an effective device in the treatment of intracranial aneurysms. Satisfactory long term occlusion rates can be achieved safely with stent-assisted coil embolization.

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“…Since the publication of the International Subarachnoid Aneurysm Trial, the treatment paradigm for intracranial aneurysms has shifted from surgical clipping to endovascular embolization ( 19 ). Moreover, recent technological advances, such as smaller coils and smoother microcatheters, and accumulated operator experience have improved the safety and efficacy of endovascular treatment of tiny aneurysms ( 20 ). In a meta-analysis that included 1,105 tiny aneurysms (844 ruptured and 261 unruptured), immediate and long-term complete occlusion rates were 85 and 91%, respectively, and rates of intraprocedural rupture and thromboembolism were 7 and 4%, respectively ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

Neuroform atlas stent-assisted coiling of tiny wide-necked intracranial aneurysms

Dong

Chen²,

Wang³

et al. 2022

Front. Neurol.

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ObjectiveTo investigate the safety and efficacy of Neuroform Atlas stent-assisted coiling for the treatment of tiny wide-necked intracranial aneurysms and evaluate risk factors associated with procedure-related complications.MethodsWe retrospectively examined 46 patients with 46 tiny wide-necked aneurysms who were treated using Atlas stent-assisted coiling at our institution from August 2020 to May 2022. Patient and aneurysm characteristics, procedural details, procedure-related complications, and angiographic and clinical outcomes were analyzed.ResultsA total of 10 patients presented with aneurysmal rupture. Atlas stent placement was successful in all patients. Angiography immediately after the procedure showed complete occlusion in 38 patients (82.6%), neck remnant in 7 (15.2%), and partial occlusion in 1 (2.2%). The mean angiographic follow-up was 8.4 months (range, 6–16). At the last follow-up, angiography showed complete occlusion in 41 patients (89.1%) and neck remnant in 5 (10.9%). No aneurysm recurrence or in-stent stenosis occurred. Incidence of procedure-related complications was 10.8% (intraprocedural aneurysm rupture, two cases; acute thrombosis, two cases; and coil migration, one case); only one patient (2.2%) experienced procedural neurological morbidity. The mean clinical follow-up was 9.7 months. A favorable outcome was achieved in 45 patients (97.8%). In univariate logistic regression analysis, aneurysm size (odds ratio, 4.538; P = 0.045) was significantly associated with procedure-related complications. However, multivariate analysis found no independent risk factors.ConclusionAtlas stent-assisted coiling of tiny wide-necked intracranial aneurysms is feasible and effective. Outcomes and occlusion rates are favorable and morbidity is low. The complication rate may be higher in larger tiny aneurysms.

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Endovascular Treatment of Tiny Aneurysms With Low-Profile Visualized Intraluminal Support Devices Using a “Compressed” Stent Technique

Cited by 4 publications

References 27 publications

Effect of the Shelving Technique on the Outcome of Embolization in Intracranial Bifurcation Aneurysms

Effect of the Shelving Technique on the Outcome of Embolization in Intracranial Bifurcation Aneurysms

Long term safety and effectiveness of LVIS Jr for treatment of intracranial aneurysms- a Canadian Multicenter registry

Neuroform atlas stent-assisted coiling of tiny wide-necked intracranial aneurysms

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