Reconstructive endovascular treatment of vertebral artery dissecting aneurysms with the Low-profile Visualized Intraluminal Support (LVIS) device

Abstract

IntroductionThe Low-profile Visualized Intraluminal Support (LVIS) device is a new generation of self-expanding braided stent recently introduced in China for stent assisted coiling of intracranial aneurysms. The aim of our study is to evaluate the feasibility, safety, and efficacy of the LVIS device in reconstructive treatment of vertebral artery dissecting aneurysms (VADAs).MethodsWe retrospectively reviewed the neurointerventional database of our institution from June 2014 to May 2016. Patients who underwent endovascular treatment of VADAs with LVIS stents were included in this study. Clinical presentation, aneurysmal characteristics, technical feasibility, procedural complications, and angiographic and clinical follow-up results were evaluated.Results38 patients with VADAs who underwent treatment with LVIS stent were identified, including 3 ruptured VADAs. All VADAs were successfully treated with reconstructive techniques including the stent-assisted coiling (n = 34) and stenting only (n = 4). Post-procedural complications developed in 3 patients (7.9%) including two small brainstem infarctions and one delayed thromboembolic event. Complications resulted in one case of minor permanent morbidity (2.6%). There was no procedure-related mortality. The follow-up angiogram was available in 30 patients at an average of 8.3 months (range, 2 to 30 months), which revealed complete occlusion in 23 patients (76.7%), residual neck in five patients (16.7%), and residual sac in two patients (6.7%). The follow-up of 25 aneurysms with incomplete immediate occlusion revealed 22 aneurysms (88%) with improvement in the Raymond class. One aneurysm (3.3%) showed recanalization and required retreatment. Clinical followed-up at 5–28 months (mean 14.1 months) was achieved in 36 patients because two patients died of pancreatic cancer and basal ganglia hemorrhage, respectively. No new neurologic deterioration or aneurysm (re)bleeding was observed.ConclusionsOur preliminary experience with reconstruction of VADAs with the LVIS device demonstrates that this treatment approach is feasible with good short-term angiographic and clinical outcomes. Long-term and larger cohort studies are necessary to determine long-term outcomes of this therapy.

Small ruptured and unruptured complex cerebral aneurysms: Single center experience of low-profile visualized intraluminal support stent

“…In this series, the angiographic obliteration rate of small complex cerebral aneurysms treated using LVIS stent was 98.5% at follow-up, which was comparable with the findings of the previous LVIS series [16]. We did not deliver the LVIS through the double-lumen balloon catheter, and the "combined remodeling technique" was not applied to avoid extra maneuvers [17].…”

“…The most common complications were periprocedural thromboembolism in retrospective and prospective studies [21]. Thromboembolic events may occur during or after the procedure, during the early follow-up, and in the late phase [16], because of the following possible causes: 1) low response or resistance of antiplatelet drugs, 2) poor stent opening or poor apposition to the vessel wall, and 3) endothelium injuries. LVIS and LVIS Jr promote excellent progressive complete aneurysmal occlusion but seem to cause more common intra-procedural stent-related thrombotic events [15,19].…”

Preliminary experience with the use of low profile visualized intraluminal support device in basilar artery for aneurysm treatment

“…These are desirable features in territories with high densities of perforators, such as the posterior circulation. We have reviewed our results with the use of the LVIS stent in intracranial vertebral artery dissecting aneurysms which showed good short term angiographic and clinical outcomes 10. However, its safety and efficacy in the basilar artery (BA) have yet to be described.…”

Endovascular Treatment of Vertebral and Basilar Artery Aneurysms with Low-Profile Visualized Intraluminal Support Device

“…[7] The LVIS design characteristics could improve the durability of endovascular treatment while avoiding impact on side branches. [8] However, the safety and e cacy of the LVIS stent to treat vertebral and basilar artery aneurysm requires further investigation. Therefore, we performed this study to evaluate the safety and e cacy of endovascular treatment for vertebral and basilar artery aneurysms using the LVIS stent.…”