Endovascular Treatment of Ruptured Wide-Necked Anterior Communicating Artery Aneurysms Using a Low-Profile Visualized Intraluminal Support (LVIS) Device

Abstract

Objective: To evaluate the safety and efficacy of low-profile visualized intraluminal support (LVIS) stent-assisted coiling for the treatment of ruptured wide-necked anterior communicating artery (ACoA) aneurysms. Methods: The clinical and angiographic data of 31 acutely ruptured wide-necked ACoA aneurysms treated with LVIS stent-assisted coiling between January 2014 and December 2018 were retrospectively reviewed. Results: All stents were successfully deployed. The immediate angiographic results were modified Raymond-Roy class I in 27 cases, modified Raymond-Roy class II in 2 cases, and modified Raymond-Roy class IIIa in 2 cases. Intraoperative thrombosis and postoperative aneurysmal rebleeding occurred in one case each. Two patients (6.5%) who were admitted due to poor clinical grade conditions died during hospital admission as a result of initial bleeding. Angiographic follow-up (mean: 12.9 months) was performed for 26 patients, the results of which demonstrated that 25 aneurysms were completely occluded and one was class II. The last clinical follow-up (mean: 25.3 months) outcomes demonstrated that 27 patients had favorable clinical outcomes and two had poor clinical outcomes. Conclusion: LVIS stent-assisted coiling for ruptured wide-necked ACoA aneurysms was safe and effective, with a relatively low rate of perioperative complications and a high rate of complete occlusion at follow-up.

Keywords: LVIS stents; anterior communicating artery; intracranial aneurysm; ruptured; safety; wide-necked aneurysms.

Figure 1

A 38-year-old man with an ACoA aneurysm treated with LVIS stent-assisted coiling. (a) A wide-necked ACoA aneurysm in which the aneurysm neck mostly involved the ACoA (solid arrow); (b) three-dimensional reconstruction of the aneurysm; (c) aplasia of the right A1 segment; (d) the microcatheter was delivered into the aneurysm sac to place the coils; (e) the stent microcatheter was exchanged to the contralateral A2 segment for stent deployment; (f) the LVIS stent (3.5 mm × 15 mm) was successfully deployed using the semi-jailing technique; (g) complete occlusion was achieved under final view (solid arrow); (h) complete occlusion (modified Raymond-Roy class I) of the aneurysm at 12-month angiographic follow-up (solid arrow).

Figure 2

A 60-year-old man with an ACoA aneurysm treated with LVIS stent-assisted coiling with a T configuration. (a) Angiogram showed a wide-neck ACoA aneurysm (solid arrow); (b) three-dimensional reconstruction of the aneurysm; (c) the LVIS stent (3.5 mm × 20 mm) was successfully deployed crossing the ACoA to the contralateral A2 segment; (d) the LVIS Jr stent (3.5 mm × 18 mm) was successfully deployed from the ipsilateral A2 to the A1 segment in a T configuration (solid arrow); (e) postoperative CT reconstruction showed that the two stents were complete opened (f) partial occlusion (modified Raymond-Roy class IIIa) was achieved under final view; (g,h) complete occlusion (modified Raymond-Roy class I) of the aneurysm at last angiographic follow-up (solid arrow).