LVIS Jr Device for Y-Stent-Assisted Coil Embolization of Wide-Neck Intracranial Aneurysms: A Multicenter Experience

Abstract

Background and Purpose: Complex wide-neck intracranial aneurysms are challenging to treat. We report a multicenter experience using the LVIS Jr stent for “Y-stent”-assisted coiling embolization of wide-neck bifurcation aneurysms. Methods: Seven centers provided retrospective data on patients who underwent Y-stenting. Technical complications, immediate posttreatment angiographic results, clinical outcomes, and imaging follow-up were assessed. Results: Thirty patients/aneurysms were treated: 15 basilar tip, 8 middle cerebral artery, 4 anterior communicating artery, 1 pericallosal, and 2 posterior inferior cerebellar artery aneurysms. The mean aneurysm size was 11 mm and the mean dome-to-neck ratio was 1.3 mm. Twenty-four aneurysms were unruptured and treated electively, and 6 were acutely ruptured. Fifty-eight LVIS Jr stents were successfully deployed without any technical issue. One pro­cedural and transient in-stent thrombosis resolved with the intravenous infusion of a glycoprotein IIb/IIIa inhibitor. Five periprocedural complications (within 30 days) occurred: 2 periprocedural neurological complications (1 small temporal stroke that presented with transient aphasia and 1 posterior cerebral artery infarct) and 3 nonneurological periprocedural complications (2 retroperitoneal hematomas, and 1 patient developed a disseminated intravascular coagulopathy). One permanent complication (3.3%) directly related to Y-stenting was reported in the patient who suffered the posterior cerebral artery infarct. Immediate complete obliteration (Raymond-Roy Occlusion Classification [RROC] I–II) was achieved in 26 cases (89.6%). Twenty-four patients had clinical and imaging follow-up (mean 5.2 months). Complete angiographic occlusion (RROC I–II) was observed in 23 patients (96%). A good functional outcome with a modified Rankin Scale score ≤2 was achieved in 26 cases. Conclusions: In this multicenter case series, Y-stent-assisted coiling of wide-neck aneurysms with the LVIS Jr device was feasible and relatively safe. Follow-up imaging demonstrated very low recanalization rates.

Advances in endovascular aneurysm management: coiling and adjunctive devices

“…At a mean follow-up of 5.2 months, 23 patients out of 26 (96%) had complete occlusion. This study supports the use of Y-stenting with the LVIS Jr device to assist in endovascular coiling of bifurcated, wide-neck cerebral aneurysms 27…”

Neuroform Atlas Stent System for the treatment of intracranial aneurysm: primary results of the Atlas Humanitarian Device Exemption cohort

“…For example, a recent LVIS stent (MicroVention, Aliso Viejo, California, USA) HDE study of 31 patients reported a technical success rate of 93.1% with ≥90% occlusion rate of 92.9% and complete occlusion rate of 75% at 6 months angiography, with 0% morbidity and mortality 8. Another 30 patient multicenter retrospective study using the braided LVIS Jr microstent demonstrated 3.3% morbidity rate with no mortality and complete occlusion rate of 76% (21/25) Raymond class I on a mean follow-up of 5.2 months, with one patient reporting permanent complications (3.3%) 9. The Canadian LVIS Jr multicenter registry of 102 patients demonstrated a complete long-term occlusion rate (defined as Raymond class I) of 68%, with 3% permanent neurological deficits, and 1% overall mortality rate 10…”

Multimodal management of giant cerebral aneurysms: review of literature and case presentation

“…Both LVIS Jr and Neuroform Atlas stents provide low profile advantages with delivery through a 0.017-inch microcatheter. Several centres have published procedural successes with both VRDs in Y-stent assisted coilings for wide-necked aneurysms 30–32. In comparison with the tubular constructs of LVIS Jr and Neuroform Atlas VRDs, the PulseRider stent was uniquely designed in two distinct shapes, T or Y, with the intention to address coiling challenges of wide-necked bifurcation aneurysms.…”