Five-Years Angiographic Follow-Up of Wide-Neck Intracranial Aneurysms Treated With LEO Plus Stent

Abstract

Background: This study aimed to evaluate the angiographic and clinical outcome, with an emphasis on long-term follow-up, of the LEO Plus stent for wide-neck intracranial aneurysms treated in a single center.Methods: We retrospectively examined a prospectively maintained database of patients treated with LEO Plus devices between January 2004 and December 2016. Data regarding patient demographics, aneurysm characteristics, and technical procedures were analyzed. Angiographic and clinical findings were recorded during the procedure and followed up over a period of at least 5 years.Results: We identified 101 patients with 116 aneurysms. In 16 patients, the stent could not safely be placed. Thus, a total of 97 LEO Plus devices were implanted in 97 aneurysms of 85 patients. Adverse events (acute and delayed) were observed in 21.6% of cases (17/85), and most were resolved (70.6%; 12/17). Moreover, 5 years after the procedure, total morbidity and mortality were 2.3% (2/85) and 3.5% (3/85), respectively. Long-term imaging follow-up showed complete occlusions, neck remnants, and residual aneurysms in 73.1% (57/78), 14.1% (11/78), and 12.8% (10/78) of cases, respectively.Conclusions: Long-term results of treatment of brain aneurysms with LEO stent show high rates of adequate and stable occlusion over time, with acceptable morbidity and mortality.

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

“…As the final angiographic results of our study showed that the rate of complete occlusion (RROC 1) was 80.0% in the SAC group, which was similar to the main results of the last 10 years (from 70 to 88.9%) ( 15 – 21 ). In the LSM group, 90.3% of aneurysms in complete occlusion (OKM grade D) was the highest rate compared to the results from other LSM studies [70.0% ( 9 ), 73.7% ( 5 )], even higher than TuBridge flow diverters (50% in OKM grades D and C) ( 22 ) or a meta-analysis of flow-diverting stents (78.7% in complete/near complete occlusion) ( 23 ) in MCA.…”

“…Pumar et al found that the rate of complete occlusion (RROC 1) of wide-neck intracranial aneurysms after Leo stent deployment increased from 39.8% at immediate post-procedural angiography to 73.1% at year 5 ( 15 ). In our study, the degree of angiographic occlusion had improved significantly during a follow-up, similar to other studies ( 16 , 25 ), again demonstrating that Leo stents have the ability to persistently promote thrombosis in the aneurysm due to the FD effect ( Figure 1 ).…”

Procedural Outcome Following Stent-Assisted Coiling for Wide-Necked Aneurysms Using Three Different Stent Models: A Single-Center Experience

“…This finding may be explained by the higher mesh density of the LEO+™ compared with the other stents; however, a bias due to the higher frequency of use of this stent at our department combined with greater experience, which is known to be critical for better outcomes in neuroendovascular procedures, cannot be excluded [ 22 ]. Additionally, Pumar et al observed slightly lower rates (73%) of complete occlusion at long-term follow-up [ 23 ]. Multivariable logistic regression analysis showed that an increasing dome/neck ratio and increased neck size were independently associated with incomplete aneurysm obliteration.…”

Endovascular Treatment of Complex Intracranial Aneurysms With LEO+ Stents: The LEO II Cohort Study

“…All our patients with complete occlusion were treated in a single procedure, except for patients for whom the treatment was staged with a stenting first and secondary coiling because of their giant aneurysms. More recently, the long-term efficacy of LEO+ stents over 5 years of follow-up has been reported ( 21 ). Retrospective work based on a more limited but demographically comparable population ( n = 101) has indicated a rate of complete or near-complete occlusion of 87.2%, a value comparable to our results.…”