The Low profile visualized Intraluminal support (LVIS) systems have been available for stent assisted coiling of intracranial aneurysms with a wide neck. Initial reports indicated that in some tortuous vessels the stent did not fully expand on deployment. Recently, the next generation LVIS device (LVIS D) was introduced with a lower brid angle promoting better stent opening and more metallic surface area (~28%) providing better neck coverage. Herein, we report our initial experience with this stent in the treatment of intracranial aneurysms.
Materials and methods The LVIS D system was deployed through a Headway 21 microcatheter in a series of patients with intracranial aneurysms. The deployment was carried out in an analogous fashion to the deployment of other braided stents and flow diverters with initial unsheathing of the stent followed by a slow push and pull technique. All patients were placed on dual antiplatelet therapy at least 5 days before treatment. In one patient, an LVIS D device was placed following prior flow diverter treatment (with incomplete aneurysm obliteration) and in another patient, a construct of 6 devices was used to create flow diversion in a fusiform aneurysm. In a third patient, it was used to salvage a flow diverter construct which had herniated into the aneurysm sac. In all others, it was placed at the neck of the aneurysm with or without coil embolization.
Results The LVIS D devices were deployed in a total of 14 patients (6 female and 8 male) aged 55 ± 12.7 years in the last year. 12 patients had saccular wide necked aneurysms and two had fusiform aneurysms. A total of 23 devices were deployed (Mean 1.6). The LVIS D device could be successfully deployed in all patients with no instances of technical failure, particularly, non-expansion. 4 patients who have had a 6 month follow up showed complete occlusion of the aneurysm (example, figure 1). No immediate peri-procedural complications linked to the device were noted in any patient. The patient with the construct for flow diversion eventually developed severe mass effect from thrombosis of the aneurysm and required a gastric tube and tracheostomy.
Conclusion Our initial experience suggests a very high technical success rate for deployment of the LVIS D device. Further follow up is need to determine its long-term efficacy.
Disclosures: B. Jagadeesan: 2; C; Microvention, Medtronic. A. Grande: 2; C; Medtronic, Integra. R. Tummala: None.
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