Safety and Efficacy of Low-Profile, Self-Expandable Stents for Treatment of Intracranial Aneurysms: Initial and Midterm Results - A Systematic Review and Meta-Analysis

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.

Stent-assisted coiling of broad-necked intracranial aneurysms with a new braided microstent (Accero): procedural results and long-term follow-up

“…However, the changes were only discreet and didn't require any therapy. In addition, there have been no in-stent stenoses, whereas in the literature a frequency of up to 10% is reported 28 .…”

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

“…The low-profile visualized intraluminal support (LVIS; MicroVention, Aliso Vajo, USA) device is a braided and self-expanding device, which has been used to treat broad-neck, complex cerebral aneurysms [1][2][3][4][5][6][7][8][9][10][11][12][13]. In a systematic review of the use of braided stents in early studies (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) involving 35 studies comprising 1426 patients [14], the overall successful stent delivery and complete aneurysm occlusion rates were 97% and 88.3%, respectively.…”

Intraaneurysmal Neck Plasty: Efficacy of a Super Compliant Double-Lumen Balloon Microcatheter

“…Balloon assist [5][6][7][8] and stent assist [9][10][11][12] embolization are representative techniques used to treat cerebral aneurysms with wide neck. Although they feature superior efficacy and widespread use, they are implemented in the parent artery rather than the aneurysm.…”