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Abstract
Introduction/Purpose Stent Assited Coiling is a well recognised treatment modality for wide neck and bifurcation aneurysms. Traditionally the stents employed have been laser cut with little to no flow diversion capabilities.The field of neurointervention is turning to alternative braided stents due to their enhanced metal coverage and flow diversion capabilities. More specifically, LVIS EVO braided stents (MicroVention, Aliso Viejo, CA, USA) allow for improved control in coil packing allowing for flow diversion capability, features of re-sheathing enabling re-positioning and deployment, eliminates the need for Y-stenting allowing the shouldering of wide neck and irregularly wide based aneurysms, and can achieve neck metal coverage of up to 25–28%. This study aims to share our institutional experience with the LVIS EVO stent in treating wide-neck and bifurcation aneurysms, highlighting its advantages and efficacy in addressing these challenging vascular conditions.
Materials/Methods 10 patients with confirmed diagnosis of wide-neck or bifurcation aneurysms treated at the Hospital of the University of Pennsylvania were reviewed retrospectively. Demographic information including sex and age alongside aneurysm description (location and size), stent technique, antiplatelet management, immediate angiographic results, and complications were collected. Descriptive and statistical analyses were conducted using R to evaluate trends and associations.
Results Patients had an average age of 71 years, and 90% (9/10) were female. Regarding aneurysm locations, 50% (5/10) had aneurysms in the basilar artery, and 30% (3/10) had aneurysms in the middle cerebral artery (MCA) bifurcation. 3 cases were treated with LVIS EVO stent coil construct, 5 cases were treated with LVIS EVO stent WEB construct while 2 cases employed LVIS EVO on its own as a flow divertor in distal vasculature. All patients had successful stent deployment and were managed with heparin and antiplatelet therapy. None of the patients experienced stent repositioning, 30-day mortality, major thromboembolic events, or hemorrhagic complications. One patient had limited thrombus formation, which was treated with a 200mcg tirofiban infusion, resulting in no further thrombus propagation or flow-limiting stenosis.
Conclusions Our single center experience demonstrates the efficacy and safety of LVIS EVO stents for the treatment of wide-neck and bifurcation aneurysms. The stents allowed for successful aneurysm coiling and parent artery reconstruction in all cases, with high metal coverage and flow diversion. No major complications occurred. Hence, the results support the use of LVIS EVO stents as a beneficial tool in the endovascular management of these complex conditions.
Disclosures O. Gandhi: None. J. Gujral: None. E. Walker: None. O. Choudhri: 2; C; Balt, Microvention, Medtronic, Qapel,Siemens, EO Solutions.