Overlapping Stents-Assisted Coiling for Vertebral Artery Dissecting Aneurysm : LVIS Stent within Neuroform EZ Stent

Liu, Xinglong; Wang, Bin; Zhao, Lei; Jia, Zhenyuan; Shi, Haibin; Liu, Sheng

doi:10.3340/jkns.2021.0275

Cited by 5 publications

(5 citation statements)

References 25 publications

(34 reference statements)

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“…Liu et al found that using multiple overlapping stents resulted in a 77.8% immediate successful embolization rate. At 21.3 months post-operation, 94.4% of patients achieved an mRS score of 0-2 [24]. Our study yielded similar results, with an immediate embolization success rate of 85.2%.…”

Section: Discussionsupporting

confidence: 78%

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Overlapping Stent Treatment for Ruptured Dissecting Aneurysms in Posterior Circulation

Zhou,

Wu,

Maalim

et al. 2023

Brain Sciences

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Ruptured dissecting aneurysms in posterior intracranial circulation present significant clinical challenges and often cause poor prognoses. Our cohort used overlapping stents as the primary treatment. We analyzed the medical records of 27 patients (18 men/nine women) with ruptured posterior circulation dissecting aneurysms (PCDAs). Their average age was 52 years. We selected 11 patients who used Enterprise (EP) and LVIS stents overlappingly and matched them 1:1 with counterparts who received either EP or LVIS stents individually. Overlapping stents was a feasible treatment in all 27 cases. We successfully followed up 26 patients for ≥6 months. Regrettably, one patient died from intracranial hypertension on Day 7 post-procedure. Immediate post-procedure angiographies indicated Raymond grade I, II, and III occlusions of PCDAs in 16 (59.3%), 7 (25.9%), and 4 (14.8%) cases, respectively. At an average follow-up duration of 16.2 months, 25 patients (96.2%) had modified Rankin Scale scores of 0–2, signifying positive outcomes. One patient (3.8%) had a score of 3–4. Recurrence rates for the EP and LVIS stent groups were higher than those of the overlapping stent group (45.45% vs. 9.09%, p = 0.15 and 27.27% vs. 9.09%, p = 0.59, respectively). No significant difference in recurrence rates existed between the overlapping and single-stent groups. Similarly, follow-up outcomes were consistent between the two groups. Overlapping stents could be an efficient method for treating ruptured PCDAs.

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Section: Discussionsupporting

confidence: 78%

“…Recently, the use of overlapping stents has been explored for treating PCDAs, demonstrating favorable conditions for enhancing blood thrombosis [24][25][26]. To the best of our knowledge, there are limited studies on treating PCDAs using overlapping stents in acute hemorrhagic scenarios.…”

Section: Introductionmentioning

confidence: 99%

Overlapping Stent Treatment for Ruptured Dissecting Aneurysms in Posterior Circulation

Zhou,

Wu,

Maalim

et al. 2023

Brain Sciences

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“…Previous reports have indicated the effectiveness and safety of treatments that involve placing a different type of closed-cell stent within an open-cell stent, with the expectation of additional effects. 6 In conclusion, visualizing the degree of stent deployment during retreatment in SAC has been challenging. However, using a balloon for stent visualization may provide a solution to this problem.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Balloon-Assisted Stent Visualization: A Simple Technique for Precise Measurement of Previously Placed Stent Diameter

Sakamoto,

Yokoya,

Takezawa

et al. 2024

Asian J Neurosurg

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Stent-assisted coil embolization is effective for treating intracranial aneurysms, improving outcomes and reducing recurrence rates. However, accurately measuring the diameter of a previously placed stent during imaging can be challenging due to coil artifacts. This poses difficulties in determining the coil packing and size of additional stents needed during retreatment. In a reported case, the use of a balloon enabled precise assessment of stent deployment. A 50-year-old male with a history of basilar artery-left superior cerebellar artery aneurysm underwent coil embolization, direct clipping, and stent-assisted coil embolization (SAC) over a span of 14 years. However, the aneurysm showed reenlargement over time. To address the recurrence, a balloon was used to assess the previously placed Neuroform Atlas stent. Additional coils were inserted outside the stent, and a Low-profile Visualized Intraluminal Support Blue stent was added. Postoperatively, there were no new neurological issues, and a follow-up magnetic resonance imaging showed no ischemic lesions. Balloon-assisted stent visualization (BASV) may be a useful method in the retreatment of SAC. It has the potential to provide valuable information for treatment planning.

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“…However, as previously demonstrated in previous study and through our own experience, using two LVIS stents can lead to stent migration when passing the microcatheter to deploy the second stent, and they may not overlap in the desired position. Furthermore, the elevated metal coverage rate increases the risk of ischemic complications 19) .…”

Section: Discussionmentioning

confidence: 99%

Clinical and Angiographic Outcomes of Endovascular Treatment for Acute Intracranial Vertebral Artery Dissecting Aneurysms Using Double-Overlapping Stents : Low-Profile Visualized Intraluminal Support within Enterprise Stents

Koo,

Hwang,

Song

et al. 2023

J Korean Neurosurg Soc

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Objective : The use of reconstructive treatment with a double-overlapping stents has proven to be effective and safe in the current treatment of intracranial vertebral artery dissecting aneurysms (VADAs). We employed a combination of overlapping stents, using low-profile visualized intraluminal support (LVIS) within the Enterprise stent. This combination was chosen to minimize the outward bulging of the inner LVIS by overlapping it with the Enterprise stent while maintaining flow diversion and stability. This study aimed to evaluate the clinical and angiographic outcomes following the use of double-overlapping stents with LVIS within the Enterprise stent for the treatment of VADAs. Methods : From March 2016 to January 2022, total 28 patients with unruptured VADAs were treated with the double-overlapping stent technique using LVIS within an Enterprise stent in our institute. The Enterprise stent was deployed first, followed by the LVIS stent. Patient clinical and angiographic characteristics, procedural complications, and follow-up outcomes were retrospectively reviewed. Results : All 28 patients (18 males and 10 females) were successfully treated with double-overlapping stent deployment. There were no procedural complications or new neurological deficits in any patient. Of the 28 patients, four VADAs had posterior inferior cerebellar artery involvement. Procedure-related parent artery occlusion did not occur during the angiographic follow-up conducted 6 to 12 months after the procedure. Out of 28 patients, 24 showed complete healing, three had focal residual stenosis or dilatation with residual sac and only one had a residual dissecting flap with aneurysm. All patients, including the four patients, did not require any additional procedures. The postoperative modified Rankin scale scores were 0-1 for all patients. Conclusion : A double-overlapping stent, with a flow-diversion effect, is a safe and effective treatment for patients with VADAs. In particular, when using the LVIS stent within an Enterprise stent, it minimizes the bulging of the inner LVIS stent while maintaining flow diversion and stability. Therefore, both can be effectively utilized as overlapping stents.

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Overlapping Stents-Assisted Coiling for Vertebral Artery Dissecting Aneurysm : LVIS Stent within Neuroform EZ Stent

Cited by 5 publications

References 25 publications

Overlapping Stent Treatment for Ruptured Dissecting Aneurysms in Posterior Circulation

Overlapping Stent Treatment for Ruptured Dissecting Aneurysms in Posterior Circulation

Balloon-Assisted Stent Visualization: A Simple Technique for Precise Measurement of Previously Placed Stent Diameter

Clinical and Angiographic Outcomes of Endovascular Treatment for Acute Intracranial Vertebral Artery Dissecting Aneurysms Using Double-Overlapping Stents : Low-Profile Visualized Intraluminal Support within Enterprise Stents

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