Treatment of Intracranial Aneurysms with Self-Expandable Braided Stents: A Systematic Review and Meta-Analysis

Abstract

BACKGROUND: The safety and efficacy of treatment with self-expandable braided stents (LEO and LVIS) required further investigation. PURPOSE: Our aim was to analyze the outcomes after treatment with braided stents. DATA SOURCES: A systematic search of 3 databases was performed for studies published from 2006 to 2017. STUDY SELECTION: According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting patients treated with LEO or LVIS stents. DATA ANALYSIS: Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and neurologic outcomes. DATA SYNTHESIS: Thirty-five studies evaluating 1426 patients treated with braided stents were included in this meta-analysis. Successful stent delivery and complete aneurysm occlusion were 97% (1041/1095; 95% CI, 95%-98%) (I 2 ϭ 44%) and 88.3% (1097/1256; 95% CI, 85%-91%) (I 2 ϭ 72%), respectively. Overall, treatment-related complications were 7.4% (107/1317; 95% CI, 5%-9%) (I 2 ϭ 44%). Ischemic/thromboembolic events (48/1324 ϭ 2.4%; 95% CI, 1.5%-3.4%) (I 2 ϭ 27%) and in-stent thrombosis (35/1324 ϭ 1.5%; 95% CI, 0.6%-1.7%) (I 2 ϭ 0%) were the most common complications. Treatment-related morbidity was 1.5% (30/1324; 95% CI, 0.9%-2%) and was comparable between the LEO and LVIS groups. Complication rates between the anterior (29/322 ϭ 8.8%; 95% CI, 3.4%-12%) (I 2 ϭ 41%) versus posterior circulation (10/84 ϭ 10.5%; 95% CI, 4%-16%) (I 2 ϭ 0%) and distal (30/303 ϭ 8%; 95% CI, 4.5%-12%) (I 2 ϭ 48%) versus proximal aneurysms (14/153 ϭ 9%; 95% CI, 3%-13%) (I 2 ϭ 46%) were comparable (P Ͼ .05). LIMITATIONS: Limitations were selection and publication biases. CONCLUSIONS: In this analysis, treatment with the LEO and LVIS stents was relatively safe and effective. The most common complications were periprocedural thromboembolisms and in-stent thrombosis. The rate of complications was comparable among anterior and posterior circulation aneurysms, as well as for proximal and distally located lesions.

Stent-Assisted Coiling of Unruptured MCA Aneurysms Using the LVIS Jr. Device: A Multicenter Registry

“…Despite the fact that our cohort consisted only of MCA aneurysms, which are considered technically challenging to treat by the endovascular approach, we achieved high immediate and long-term total occlusion rates, which are similar to, if not better than, those of other published LVIS Jr. series [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. Follow-up imaging showed complete or near-complete aneurysm occlusion in 92% of the cases.…”

“…High technical success rate (95%) was observed in our study, which is similar to previous papers. The reported rate of occurrence of in-stent thrombosis is variable in the literature [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. In another large series of aneurysms treated with the assistance of the LVIS Jr. by Shankar et al, it was observed in 14% of the cases.…”

“…The treatment-related complication rate was 7% with the ischemic and thromboembolic events being the most common. There was no case of treatment-related death in the investigated studies [ 35 ].…”

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

“…The low-profile visualized intraluminal support (LVIS; MicroVention, Aliso Vajo, USA) device is a braided and self-expanding device, which has been used to treat broad-neck, complex cerebral aneurysms [1][2][3][4][5][6][7][8][9][10][11][12][13]. In a systematic review of the use of braided stents in early studies (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) involving 35 studies comprising 1426 patients [14], the overall successful stent delivery and complete aneurysm occlusion rates were 97% and 88.3%, respectively.…”

Acute Tentorial Subdural Hematoma Caused by Rupture of the Posterior Cerebral Artery after Minor Trauma—A Case Report

“…Other treatment possibilities include endovascular or surgical parent vessel sacrifice as well as stenting or placement of flow diverters [10,15]. Some stents can be successfully deployed even in vessels with a diameter smaller than 2 mm (Neuroform-Atlas (Stryker Neurovascular) [16]; Leo Baby (Balt, Montmorency, France); LVIS (Microvention) [17,18]). In exceptional cases, TIA can thrombose and occlude spontaneously; such aneurysms are indicated by very late contrast filling on the diagnostic DSA [10].…”