Flow-T stenting with the Silk Vista Baby and Baby Leo stents for bifurcation aneurysms – A novel endovascular technique

Makalanda, Hegoda Levansri Dilrukshan; Wong, Ken; Bhogal, Pervinder

doi:10.1177/1591019919870618

Cited by 15 publications

(16 citation statements)

References 23 publications

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“…26 In addition, we consider this new stent system as a perfect candidate for some alternative stenting techniques such as the 'Flow-T' setting or modified deployment manoeuvres such as the 'railroad switch'. 27,28 On the contrary, there is a certain concern regarding the new LVIS EVO stent observed in our series. Based on the discretion of the main operator and the fact that the new system comes with reduced nominal diameter and potentially lower radial force, each stent we used was slightly oversized with minimum 0.25 mm to the diameter of the target parent artery.…”

Section: Discussionmentioning

confidence: 73%

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Endovascular treatment of patients with intracranial aneurysms: feasibility and successful employment of a new low profile visible intraluminal support (LVIS) EVO stent

et al. 2020

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Background and purpose Low-profile self-expandable stents have increased the number of intracranial aneurysms treated by endovascular means. The new low-profile visible intraluminal support device LVIS EVO (Microvention), the successor of LVIS Jr, is a self-expandable and retrievable microstent system, designed for implantation into intracranial arteries with a diameter up to 2.0 mm. In this retrospective study we aimed to elucidate the technical feasibility and clinical safety of the novel LVIS EVO stent for stent-assisted coil embolisation of intracranial aneurysms. Materials and methods A single centre technical report of the first six consecutive cases of stent-assisted coil embolisation with the novel LVIS EVO stent for the treatment of unruptured or recanalised intracranial aneurysms. Records were made of basic demographics, aneurysmal characteristics, device properties and related technical details, adverse events, clinical outcomes and occlusion rates on available radiological follow-up. Results Six LVIS EVO devices were successfully implanted in all subjects to treat a total number of six intracranial aneurysms. No device-related intraprocedural complications were seen. At early clinical follow-up six out of six (100%) patients had a modified Ranking score of 0–1. Early angiographic and cross-sectional radiological follow-up, available in five out of six (83.3%) of the patients confirmed unchanged aneurysmal occlusion rates. A minor, transitory neurological deficit was recorded in one of the six (16.6%) patients. Mortality was 0%. Conclusions Preliminary experience in this subset of our patients confirms a notably improved technical behaviour of the novel LVIS EVO stent system when compared to its ancestor LVIS Jr. The enhanced visibility of the stent and the refined delivery/retrieval capabilities of the stent further increase the safety margins of the devices profile, especially in cases of tortuous anatomy.

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Section: Discussionmentioning

confidence: 73%

“…26 In addition, we consider this new stent system as a perfect candidate for some alternative stenting techniques such as the ‘Flow-T’ setting or modified deployment manoeuvres such as the ‘railroad switch’. 27,28…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of patients with intracranial aneurysms: feasibility and successful employment of a new low profile visible intraluminal support (LVIS) EVO stent

et al. 2020

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“…BAC potentially causes significant technical stress for aneurysm and parent vessel. Indirect, causal treatments like stent-based approaches 11 avoid this. The most significant drawback of this approach is the necessity for dual antiplatelet therapy.…”

Section: Discussionmentioning

confidence: 99%

Balloon-assisted coiling of intracranial aneurysms using the Eclipse 2L double lumen balloon

et al. 2020

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Background Eclipse 2L is a new double lumen balloon microcatheter for neurovascular use, with several design features that separate it from previous generation devices. We aimed to report our initial experience of balloon-assisted coiling of intracranial aneurysms using the Eclipse 2L balloon. Materials and methods Retrospective single-center review of patients who underwent balloon-assisted coiling with the Eclipse 2L balloon, for ruptured or unruptured intracranial aneurysms between 1 June 2016 and 31 December 2018. Cases with adjunctive use of stents and recurrences of previously embolized aneurysms were excluded. Patient files were used to extract aneurysm characteristics, complications, immediate and long-term results. Results We identified 120 patients with 126 aneurysms, of which 83 (65.8%) unruptured. Average aneurysm size was 5.9 mm (standard deviation 3.2 mm), with a dome-to neck-ratio of 1.7 (SD 0.6). Most aneurysms (79.3%) were wide necked. Immediate angiographic exclusion (Raymond-Roy grade I–II) was obtained in 95.1% of cases (81.7% grade I and 13.4% grade II). Procedural morbidity was 3.2% with no procedural mortality. Follow-up imaging was available for 115 aneurysms (91.2%). After an average follow-up period of 8.9 months (SD 7.3 months), 96.5% of aneurysms presented class I–II occlusion. Two aneurysms (1.7%) were retreated during follow-up. Conclusion Balloon-assisted coiling using the Eclipse 2L double lumen balloon is feasible for aneurysms in a wide range of locations in the anterior and posterior circulation. The angiographic results and complication rates compare favorably with previously published studies.

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“…In a recent case report, Makalanda et al. 13 described the combination of a SVB and a Baby Leo Stent in T configuration for the treatment of a MCA bifurcation aneurysm showing that the technique is replicable with this low-profile FD.…”

Section: Discussionmentioning

confidence: 99%

Transcirculation Silk Vista Baby-assisted coiling in half-T configuration for the treatment of posterior communicating artery aneurysms associated with a fetal posterior circulation: An alternative flow diversion strategy

et al. 2020

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Flow diverter devices have become a routine first-line option for treatment of an increasing population of intracranial aneurysms at many neurovascular centers. Despite the promising results of flow diverter stents on anterior circulation, incomplete occlusion on the presence of fetal posterior circulation has been described on several reports. Here we describe a novel technical alternative to conventional flow diversion approach for this specific subgroup of aneurysms using the low-profile flow diverter, Silk Vista Baby. The device was selectively placed into the fetal type posterior cerebral artery in half-T configuration for the treatment of a posterior communicating aneurysm using a transcirculation approach through the anterior communicating artery. This represents a useful and effective technique and should be considered when encountering the above-described situation.

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Flow-T stenting with the Silk Vista Baby and Baby Leo stents for bifurcation aneurysms – A novel endovascular technique

Cited by 15 publications

References 23 publications

Endovascular treatment of patients with intracranial aneurysms: feasibility and successful employment of a new low profile visible intraluminal support (LVIS) EVO stent

Endovascular treatment of patients with intracranial aneurysms: feasibility and successful employment of a new low profile visible intraluminal support (LVIS) EVO stent

Balloon-assisted coiling of intracranial aneurysms using the Eclipse 2L double lumen balloon

Transcirculation Silk Vista Baby-assisted coiling in half-T configuration for the treatment of posterior communicating artery aneurysms associated with a fetal posterior circulation: An alternative flow diversion strategy

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