Introduction Braided stents offer a number of potential advantages over open cell stents in the treatment of wide necked aneurysms. Still, there are concerns of technical challenges with treatment with braided stents; especially in complex configurations at bifurcation points, such as ‘Y’-stenting. We report our technical results with ‘Y’ stent configurations of the LVIS Jr stent (Microvention, Inc, Tustin, CA).
Materials and methods An internal department database was queried for all cases of bifurcation aneurysms, from a single surgeon, treated with the LVIS Jr stent in ‘Y’ stent configurations between January 2013 and February 2018. All aneurysms were treated with a single microcatheter technique wherein, following deployment of the stents, both stents were re-crossed by the microcatheter to catheterize the aneurysm. All treatments were performed through the Headway line of microcatheters (Microvention, Inc, Tustin, CA). For the catheterization of the aneurysm, if difficulty was encountered attempting to cross the stents with a Headway 17 microcatheter it was practice to then attempt the catheterization with a 1.3 F Headway Duo 167 cm length microcatheter.
Results Eighteen aneurysms in 17 patients were identified. The aneurysm site was the basilar tip in 7 and the anterior communicating artery in 11. There were 14 females and 4 males treated with an average age of 59.7 years. Two aneurysms were treated in the acute period following rupture and another 8 of the aneurysms were recurrent. There was a high technical success rate. All stents were successfully deployed and 17 of 18 (94.4%) of the aneurysms were successfully catheterized through the stents. Of those aneurysms with available follow up imaging 14 of 15 (93.3%) had Raymond Grade 1 or 2 embolizations. There was one aneurysm with coil compaction and regrowth of a Raymond Grade 2 embolization that required retreatment. In terms of safety, there were 2 immediate post procedure symptomatic strokes with complete neurological recovery in both patients. There was a single delayed symptomatic stroke at 6 months when a patient inappropriately stopped her antiplatelet therapy. There were no intraprocedural or delayed aneurysm ruptures. The total neurological morbidity was 3 of 18 treatments (16.6%). There were no mortalities and all patients, at follow up, have an mRS ≤2.
Conclusion ‘Y’ stent assisted coil embolization of cerebral aneurysms with the braided, low profile LVIS Jr stent, via a single microcatheter technique, is technically feasible and can achieve good radiographic results. In our small sample the rate of morbidity may be higher than the reported incidence for less complex single braided stent constructs.
Disclosures C. Son: None. Y. Li: None. D. Niemann: None.
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