Flow diversion effect of the leo braided stent for aneurysms in the posterior and distal anterior circulations: A multicenter cohort study

Duan, Yu; Xu, Bin; Qin, Xuanfeng; Mao, Ruolin; Hu, Yuanyuan; Zhou, Bin; Li, Jian; Chen, Gong

doi:10.3389/fneur.2022.957709

Cited by 6 publications

(7 citation statements)

References 36 publications

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“…Leo stent has been indicated for intracranial aneurysm, but it has also been reported to be used in a few case reports of VBD besides enterprise and Solitaire. [7][8][9] Besides using multiple Leo stent, nondominant vertebral artery occlusion was also performed to reduce the blood flow into the space between the stents and the vascular wall, which can further improve the hemodynamics of the VBD. The occlusion should be performed as distal vertebral artery as possible to prevent occlusion of posterior inferior cerebellar artery and anterior spinal artery, but not to distal to obstruct This combination of technique has been reported as well in several studies.…”

Section: Discussionmentioning

confidence: 99%

Successful endovascular reconstruction of symptomatic vertebrobasilar dolichoectasia using multiple Leo stents and nondominant vertebral artery occlusion: a case report

Soetanto,

Ganiem,

Adam

et al. 2024

Int J Res Med Sci

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Vertebrobasilar dolichoectasia (VBD) is a rare vascular anomaly of increased diameter, length, and tortuosity of vertebral and/or basilar artery, but debilitating due to its risk of ischemia, hemorrhage, and nerve or brain compression. The management is also controversial due to various possible clinical manifestation and outcome. This study aimed to describe a combined approach of multiple scaffolding Leo stents and nondominant vertebral artery occlusion as a definitive approach to reconstruct vertebrobasilar arteries. A 40-year old male presented with severe headache and reduced consciousness, which was explained with brain CT findings of subarachnoid hemorrhage and hydrocephalus. Further etiologic approach until digital subtraction angiography revealed VBD. An endovascular reconstruction approach was considered one month following the event onset using multiple scaffolding Leo stents from left vertebral to basilar artery with right vertebral artery occlusion. This stent had the best radial strength, lowest bending stiffness, highest kink resistance, highest bending wall coverage, and lowest cell size, which provided strong vascular reconstruction properties. Combined nondominant vertebral artery occlusion was also performed to avoid the disturbance of flow-diverting pathway by the stents. Double antiplatelet was administered from three weeks following the event onset afterwards. The patient’s condition improved at three-month follow-up. This case report presented that combined multiple Leo stents and nondominant vertebral artery occlusion may be considered as an approach to successful endovascular reconstruction for symptomatic VBD.

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Section: Discussionmentioning

confidence: 99%

Successful endovascular reconstruction of symptomatic vertebrobasilar dolichoectasia using multiple Leo stents and nondominant vertebral artery occlusion: a case report

Soetanto,

Ganiem,

Adam

et al. 2024

Int J Res Med Sci

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“…In the literature, progressive occlusion of a “significant proportion” of coiled aneurysms and diminished recanalization rates have been proposed as proxies for the flow diversion effect of a stent [ 9 , 14 , 22 ]. Consequently, in this study, to investigate the flow diverter effects of different types of stents, aneurysms were divided into two groups.…”

Section: Methodsmentioning

confidence: 99%

“…Braided stents (BS) are suggested to have flow-diverting properties [ 5 , 6 , 7 , 8 , 9 , 10 ]. However, the presence of this effect has been disputed by some authors [ 11 , 12 , 13 ], and if such a flow diversion property exists at all, its extent has remained unknown to date [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Appraisal of the Flow Diversion Effect Provided by Braided Intracranial Stents

Çay,

Arat

2024

JCM

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Objective: Comparison of the results of stent-assisted coiling (SAC) with braided stents (BS), flow diverters (FD), and laser-cut stents (LCS) to determine the relative flow-diverting capacity of BS (Leo baby and Accero). Methods: Saccular intracranial aneurysms treated by SAC and FD-assisted coiling were retrospectively evaluated. Aneurysm occlusion, as graded per Raymond–Roy score, was categorized as either recanalization/stable residual filling (Group A; lacking a flow diversion effect) or stable/progressive occlusion (Group B with a “flow diversion effect”). Factors predicting the flow diversion effect were evaluated. Results: Of the 194 aneurysms included, LCS, BS, and FD were used in 70 (36.1%), 86 (44.3%), and 38 (19.6%) aneurysms, respectively. Aneurysms treated by FD were larger, had wider necks, and were located on larger parent arteries (p < 0.01, 0.02, and <0.01, respectively). The mean imaging follow-up duration was 24.5 months. There were 29 (14.9%) aneurysms in Group A and 165 (85.1%) in Group B. Among a spectrum of variables, including sex, age, aneurysm size, neck width, parent artery diameter, follow-up duration, and stent type, the positive predictors for stable/progressive aneurysm occlusion were aneurysm size and placement of an FD or BS (p < 0.01 and p < 0.01, respectively, and were positive predictors over LCS: ORs 6.34 (95% CI: 1.62–24.76) and 3.11 (95% CI: 1.20–8.07), respectively) in multivariate analysis. Conclusions: The placement of BS was a predictor of flow diversion over laser-cut stents. However, the flow diversion effect was approximately half that of FDs, suggesting that BS may only be considered to have some (partial) flow diversion effects.

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“… 21) Another recent report showed that the rates of complete occlusion, permanent morbidity, and mortality were 90.4%, 2.0%, and 0%, respectively. 22) Neck-bridging stents or SAC continue to advance, leading to the development of novel therapeutic devices.…”

Section: Stent-assisted Coilingmentioning

confidence: 99%

Endovascular Treatment of Wide-Neck Bifurcation Aneurysm: Recent Trends in Coil Embolization with Adjunctive Technique

Haryu,

Sakata,

Matsumoto

et al. 2024

JNET

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Wide-neck bifurcation aneurysms (WNBAs) are sometimes challenging to treat. During endovascular treatment, it is important to prevent coil deviation and preserve normal vessels. Adjunctive balloon- and stent-assisted techniques have been developed. A meta-analysis of endovascular treatments of WNBAs revealed that only 40% of patients had complete occlusion. Recently, novel devices have been developed to expand the range of treatment options. Flow-diverter stents and intra-aneurysmal flow disruption devices do not require coils; however, coil embolization remains the standard procedure used by many neurointerventionists. This review describes the recent trends in adjunctive techniques for supporting coil embolization for WNBAs. We referred to literature on balloon-assisted techniques, stent-assisted techniques, Y-stenting, PulseRider, Barrel stents, Comaneci temporary stents, pCONUS, and eCLIPs. These reports showed that adequate embolization rates were generally greater than 80%, and the complete occlusion rate was as high as 94.6%. All devices had a relatively high occlusion rate; however, it may be inaccurate to simply compare each device because of the heterogeneity of the studies. It is important to select the best treatment for each individual case by considering not only literature-based efficacy and safety but also patient background, aneurysm characteristics, and operator experience.

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Flow diversion effect of the leo braided stent for aneurysms in the posterior and distal anterior circulations: A multicenter cohort study

Cited by 6 publications

References 36 publications

Successful endovascular reconstruction of symptomatic vertebrobasilar dolichoectasia using multiple Leo stents and nondominant vertebral artery occlusion: a case report

Successful endovascular reconstruction of symptomatic vertebrobasilar dolichoectasia using multiple Leo stents and nondominant vertebral artery occlusion: a case report

Appraisal of the Flow Diversion Effect Provided by Braided Intracranial Stents

Endovascular Treatment of Wide-Neck Bifurcation Aneurysm: Recent Trends in Coil Embolization with Adjunctive Technique

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