LVIS Jr. stent for treatment of intracranial aneurysms with parent vessel diameter of 2.5 mm or less

Abstract

Background and purpose This retrospective study evaluates the safety, effectiveness, and long-term clinical and angiographic follow-up of intracranial aneurysms treated with the Low-Profile Visualized Intraluminal Support Junior (LVIS Jr.) stent and parent vessels of diameter equal to or less than 2.5 mm. Materials and methods We included all patients treated with the LVIS Jr. stent in aneurysms with small parent vessel diameter between March 2015 and July 2017. Periprocedural adverse events, immediate aneurysm occlusion rates, and clinical and angiographic follow-up are reported. Results A total of 35 patients with 35 aneurysms were included. Ten aneurysms were ruptured (28.6%) and 25 were unruptured (71.4%). The parent arteries measured 0.9 mm to 2.5 mm in diameter (mean, 2.2 mm). Intra-procedural thromboembolic complications occurred in four patients (11.4%) and there was an intraoperative aneurysm rupture in one patient (2.8%). Immediate complete aneurysm occlusion was noted in 21 out of 35 patients (60%). Clinical follow-up ranged between one and 25 months (mean, 10.5 months) and magnetic resonance angiography follow-up ranged between four and 24 months (mean, 10.4 months). Complete aneurysm occlusion was achieved in 21 out of 29 patients (72.4%) at last angiographic follow-up (mean, 9.4 months; range four to 23 months). In-stent stenosis occurred in one out of 29 patients (3.4%), who was asymptomatic. Of the four patients with in-stent thrombosis, three patients were treated with "Y configuration" (two patients with middle cerebral artery aneurysms and one patient with an anterior communicating artery aneurysm). Mortality rate was 0%. Neurological morbidity was 2.9%. Conclusions Stenting with the LVIS Jr. stent allowed us to treat complex intracranial aneurysms with parent vessel diameter of 2.5 mm or less with an acceptable safety profile.

Keywords: Intracranial aneurysm; LVIS stent; small parent vessel diameter.

Figure 1.

(a) A 74-year-old female with an incidental finding of a right distal pericallosal artery aneurysm with a 4 × 2.1 mm and 3.5 mm neck with a proximal parent vessel diameter of 1.3 mm and a distal parent vessel diameter of 0.9 mm. (b) Successful stenting-assisted coiling with the Low-Profile Visualized Intraluminal Support Junior (LVIS Jr.) 2.5 × 17 mm. (c) Unsubtracted view showing the coil mass and the LVIS stent.

Figure 2.

A 67-year-old female with an unruptured left middle cerebral artery bifurcation aneurysm. (b) She underwent placement of two Low-Profile Visualized Intraluminal Support Junior stents measuring 2.5 × 17 mm and 2.5 × 23 mm in a Y-configuration. (c) The patient developed in-stent thrombosis that completely resolved after intra-arterial abciximab infusion.