Intracranial Complex Ruptured Aneurysms Coiled with Overlapping Low-Profile Visualized Intraluminal Support Stents: Another Available Option for Complex Ruptured Intracranial Aneurysms

Yan, Zhiyuan; Kuang, Zheng; Xiong, Ye; Lan, Fujun; Wang, Yunhui; Tan, Xiaojie; Ming, Zhong; Li, Zequn

doi:10.1016/j.wneu.2018.12.142

Cited by 11 publications

(9 citation statements)

References 23 publications

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“…For blood blister like aneurysms, the overlapping stents were not used [18], and we generally used single stent-assisted coiling. In a meta-analysis involving 384 patients with 390 aneurysms, the overall technical success rate of LVIS was 96.8% [19]. The aneurysmal complete obliteration rate was 54.6% on immediate control and 84.3% on follow-up angiograms.…”

Section: Discussionmentioning

confidence: 97%

“…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].…”

Section: Discussionmentioning

confidence: 99%

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

Lv¹,

Jiang²,

Liang³

2019

Journal of Neurorestoratology

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Objectives:Even though low-profile visualized intraluminal support (LVIS) device is used extensively currently and provide intraluminal support in complex cerebral aneurysm embolization, only few studies have reported its clinical results. This study presents the results of patients treated with LVIS.Patients and methods:Cerebral aneurysms with an undefined neck, fusiform shape, and blood blister-like aneurysms that were treated with LVIS between May 2017 and May 2019 were reviewed retrospectively.Results:Overall, 112 aneurysms in 104 patients were treated using LVIS, and 105 LVISs were placed. Of these, 101 aneurysms (90%) were small (< 10 mm) in size, 17 were fusiform aneurysms, and 3 were blood blister-like aneurysms. Overall, 39 patients suffered a subarachnoid hemorrhage and 65 had no bleeding history. 2 patients died of internal carotid artery (ICA) thrombosis, resulting in 1.9% mortality rate. Follow-up angiography was obtained in 68 patients (65%), and the complete obliteration rate was 98.5% in 6–12 months.Conclusion:The LVIS is a safe and effective treatment for small ruptured or unruptured complex intracranial aneurysms.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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

Lv¹,

Jiang²,

Liang³

2019

Journal of Neurorestoratology

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“…Flow reduction was achieved in three out of four aneurysms by overlap stenting. It has been reported that multiple overlapping LVIS stents have a similar flow diversion effect as that of FD (6,8). Metal coverage of the aneurysm orifice is one of the important factors causing a flow diversion effect.…”

Section: Discussionmentioning

confidence: 98%

“…Reduction of intraaneurysmal flow often contributes positively to the treatment of cerebral aneurysms. However, unpredictable flow changes are possible with this treatment (5)(6)(7). Previous computational fluid dynamics (CFD) studies have shown that multiple lowprofile visualized intraluminal support (LVIS) devices have flow diversion effects (8).…”

Section: Introductionmentioning

confidence: 99%

Possibility of Worsening Flow Diversion Effect Due to Morphological Changes of a Stented Artery With Multiple Overlapping Stents for Partially Thrombosed Vertebral Artery Aneurysms

et al. 2020

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Background: Morphological changes of a stented artery can cause a flow diversion effect to reduce intra-aneurysmal flow; however, there is a potential for the negative effect of increased intra-aneurysmal flow. We present cases with multiple overlapping stents for a partially thrombosed vertebral artery aneurysm and characterize the hemodynamic properties of a recurrent case by focusing on the morphological changes of the stented artery.Methods: Between October 2017 and April 2019, four consecutive cases of symptomatic unruptured large and giant partially thrombosed vertebral artery aneurysms were treated with multiple overlapping low-profile visualized intraluminal support stents and no coils. Both angiographic and clinical outcomes were assessed. Computational fluid dynamics analysis was performed to clarify hemodynamic features. The degree of pressure elevation was calculated as the pressure difference (Pd). Wall shear stress (WSS) was also calculated.Results: In three of the four cases, successful flow reduction was achieved with no morphological change of the stented arteries. The patients' symptoms were gradually improved. The remaining case required additional stents after the initial treatment. In the recurrent case, Pd was noticeably elevated at the aneurysm neck after treatment, and WSS was generally increased in the area due to altered blood flow into the aneurysm dome caused by morphological changes of the stented artery.Conclusion: Overlapping stents can be used for the treatment of large and giant thrombosed vertebral artery aneurysms with flow diversion effect; however, morphological changes of the stented artery requires careful attention as it may lead to an increase in the intra-aneurysmal flow, causing negative outcomes.

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“…On right vertebral arteriography, bending and occlusion was acquired by additional LVIS placement in one case, achieving a favorable outcome with a final occlusion rate of 92.3% (12/13). Yan et al 13) treated 15 aneurysms (ICA: 5, VA: 5, basilar artery [BA]: 2, middle carotid artery [MCA]: 1, PcoA: 1, Acho A: 1) by overlapping stenting using 2 LVIS in 10 patients. Coil embolization was concomitantly applied to 13 aneurysms and 2 were treated by stenting alone.…”

Section: Discussionmentioning

confidence: 99%

Double LVIS Jr. Stenting of a Ruptured Proximal Anterior Inferior Cerebellar Artery Aneurysm: A Case Report

Kuwayama

Nakata

Furuno

et al. 2021

JNET

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A 53-year-old woman presented with headache. CT demonstrated subarachnoid hemorrhage. DSA revealed no evident source of bleeding. On day 10, she complained of sudden headache and CT demonstrated rebleeding. On repeated DSA, an aneurysm at the anterior pontine segment of the right AICA was found. An LVIS Jr. stent was deployed at the right AICA including the aneurysm. On postoperative day 23, the aneurysm ruptured again. Another LVIS Jr. stent was deployed at the same area. On day 56, she was discharged home without neurological deficit. Conclusion: Intracranial aneurysms not indicated for coil embolization or parent artery occlusion are difficult to treat. Overlapping stenting may be a treatment option for such aneurysms.

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Intracranial Complex Ruptured Aneurysms Coiled with Overlapping Low-Profile Visualized Intraluminal Support Stents: Another Available Option for Complex Ruptured Intracranial Aneurysms

Cited by 11 publications

References 23 publications

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

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

Possibility of Worsening Flow Diversion Effect Due to Morphological Changes of a Stented Artery With Multiple Overlapping Stents for Partially Thrombosed Vertebral Artery Aneurysms

Double LVIS Jr. Stenting of a Ruptured Proximal Anterior Inferior Cerebellar Artery Aneurysm: A Case Report

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