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Hemorrhagic Stroke
Case series
A clinical comparison of Atlas and LVIS Jr stent-assisted aneurysm coiling
  1. Bradley A Gross1,2,
  2. William J Ares1,2,
  3. Andrew F Ducruet3,
  4. Ashutosh P Jadhav1,4,
  5. Tudor G Jovin1,4,
  6. Brian Thomas Jankowitz1,2
  1. 1 UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  2. 2 Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsbuegh, Pennsylvania, USA
  3. 3 Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  4. 4 Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Bradley A Gross, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; grossb2{at}upmc.edu

Abstract

Background Case series have described the safety and efficacy of LVIS Jr and Atlas stent-assisted aneurysm coiling, but their comparative clinical performance has not yet been formally studied.

Objective To clinically compare LVIS Jr and Atlas stents, emphasizing comparative rates of technical success and complications.

Methods Our institutional endovascular database was queried for aneurysms treated by stent-assisted coiling with either the LVIS Jr or Atlas stents. Demographic data, aneurysm information, treatment technique, periprocedural and device-related complications, and initial and follow-up angiographic results were evaluated.

Results Thirty-seven patients underwent Atlas stent placement and 27 patients underwent LVIS Jr stent placement for aneurysm coiling. There was no significant difference in aneurysm location, size, coiling technique, and coil packing density between the two cohorts. The rate of initial Raymond 1 occlusion was significantly greater in the Atlas cohort (57% vs 41%, P=0.03). The rate of postoperative ischemic complications, both clinically apparent and as defined on postoperative MRI diffusion-weighted imaging, did not significantly differ between the two groups. Follow-up DSA demonstrated a significantly greater rate of Raymond 1 or 2 occlusion for the Atlas cohort (100% vs 81%, P=0.04), and a significantly lower rate of in-stent stenosis (0% vs 19%, P=0.04).

Conclusion This institutional analysis demonstrates greater obliteration rates and lower in-stent stenosis rates for aneurysms treated via Atlas stent-assisted coiling as compared with those treated via LVIS Jr stent-assisted coiling.

  • aneurysm
  • coil
  • stent
  • stenosis
  • stroke

https://doi.org/10.1136/neurintsurg-2018-014208

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    Footnotes

    • Contributors BAG: drafting of the article. BAG, WJA: acquisition of data/data analysis. All authors: review and revision of article before submission. BTJ: study supervision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests TGJ received a grant, non-financial, from Fundació Ictus Malaltia Vascular and modest honoraria from Silk Road (consultant), Medtronic and Stryker Neurovascular (consultant/advisory board), and Neuravi (consultant). BTJ is a consultant for Medtronic and Stryker Neurovascular (Co-PI, ATLAS study). AFD is a consultant for Medtronic and Penumbra.

    • Patient consent Not required.

    • Ethics approval Pittsburgh local institutional review board (UPMC).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement N/A.