Introduction Very wide necked aneurysms that incorporate a large portion of the parent artery can be challenging to treat with currently available devices. Stents can assist in reconstructing the vessel wall, but often result in suboptimal coiling of the underlying aneurysm. We report 2 cases treated with a new hybrid stent design that incorporates a smaller and more pliable design than current generation stents and results in some flow diversion characteristics.
Material and Methods The first case is a 57-year-old female history suggesting SAH 7 weeks ago based on LP and a vertebral aneurysm was identified. The aneurysm was found to measure 9 mm long×5.5 mm deep w/7.7 mm neck with circumferential involvement of vertebral artery and also involving adjacent distal segment of vertebral artery. The patient was pretreated with Plavix and Aspirin. The vertebral artery was reconstructed with the Low Profile Visible Intraluminal Support (LVIS) Device (Microvention, Tustin California, USA) while jailing a microcatheter in the aneurysm and then coil embolization performed. At the conclusion of the procedure a small region of persistent aneurysm filling was noted and this was catheterized through the LVIS with an SL-10 microcatheter and further coil embolization performed. The patient went home the following day at baseline clinical condition. The second case is a 67-year-old man who underwent elective MCA clipping 2005 (incomplete). He presents with a SAH (March 16, 2011) from the right MCA aneurysm that had enlarged over time. He has basilar fusiform aneurysm and left Carotid fusiform dilation and chronic headaches. After 1 month of recovery, the patient was readmitted from rehab and pretreated with Plavix and Aspirin. The MCA aneurysm was found to measure 15 mm×14 mm and to circumferentially involve the M1 trunk. The MCA artery was reconstructed with the LVIS device while jailing a microcatheter in the aneurysm and then coil embolization performed. At the conclusion of the procedure persistent aneurysm filling was noted in the proximal aspect of the aneurysm and this was catheterized through the LVIS with an SL-10 microcatheter and further coil embolization performed. Subsequently, two additional telescoping LVIS devices were deployed to reconstruct the proximal fusiform supraclinoid ICA. The patient was transferred back to the rehabilitation facility at baseline neurological condition. Short-term follow-up demonstrates the patient no longer has daily chronic headaches.
Discussion Wide necked aneurysms often require stent reconstruction of the parent artery. Currently available devices are poorly visualized with large interstices that may allow coil herniation into the stent lumen. The LVIS device is well visualized throughout its course and maintains a cell structure that enables catheterization through the interstices without compromising coil support. This allowed for treatment of difficult aneurysms, even when coiling circumferentially around the device.
Conclusions Both patients were able to undergo aneurysm stent assisted coiling of very challenging aneurysms with the LVIS device with good angiographic and clinical outcomes.
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Disclosures R Turner: MicroVention. A Turk: MicroVention. M Chaudry: MicroVention.