Potential advantages and limitations of the Leo stent in endovascular treatment of complex cerebral aneurysms

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Abstract

Objective

The Leo self-expandable stent is a new retractable stent that is delivered via a conventional catheter. The aim of this study was to evaluate the use of this stent for endovascular treatment of complex aneurysms.

Methods

Twenty-eight complex cerebral aneurysms (27 saccular and 1 fusiform) in 28 patients were treated electively. They were located at the internal carotid artery (17), basilar trunk (3), anterior cerebral artery (1), anterior communicating artery (3), vertebral artery (2) and middle cerebral artery (2). One aneurysm exhibited recanalization after primary endovascular treatment without stent. Clinical outcome was assessed with the modified Glasgow Outcome Scale.

Results

Deployment of Leo stent was successful in 26 lesions, and difficulties in stent positioning due to tortuous cerebral circulation in 2 cases, which were treated with Neuroform stent. Additional coil embolization was performed in 26 lesions. No permanent neurological deficits were encountered consequent to endovascular procedure. Complete or partial occlusion immediately after stent deployment was achieved in all aneurysms. There was no immediate coil embolization was chosen in 3 cases because of subsequent reduced filling of the aneurysms with contrast agent on angiograms. There were 3 asymptomatic parent artery occlusion related to the deployment of the Leo stent, one stent migration. Follow-up revealed patent stents in the remaining cases. No angiographic recurrences arose.

Conclusion

The Leo stent is very useful for endovascular treatment of complex cerebral aneurysms because it is easy to navigate and place precisely. A drawback is that in-stent thrombosis caused by stent placement and stiffer delivery catheters to place larger stents.

Section snippets

Population

Between January 2007 and June 2009, consecutive 28 patients with 28 complex cerebral aneurysms were treated with the Leo stent to evaluate its potential advantages and disadvantages (Table1). The study consisted of 15 women and 13 men with a mean age of 52 years (range, 25–78 years). Seventeen patients had a history of subarachnoid hemorrhage, 8 patients had incidental aneurysms, 1 patient presented with complex recanalization from a previously coiled aneurysm, 1 presented with occulomotor

Results

Selective embolization was successfully performed and resulted in an excellent clinical outcome in all patients. In all but 2 patients (7.1%), the Vasco catheter was very easily navigated and positioned with a Synchro 14 microguidewire past the aneurysm neck. These 2 patients presented with 2 ICA aneurysms that was located on a very tortuous ICA. A previous attempt of endovascular treatment with the Leo stent failed because the delivery catheter appeared too stiff and Neuroform stent was used.

Patient 7

A 28-year-old woman presented with grade 1 SAH. The patient underwent conventional angiography and three-dimensional angiography showed a wide-necked aneurysm of the mid-basilar artery. The aneurysm was treated with the Leo stent (Fig. 1). A 3.5-mm × 25-mm Leo stent was placed. Then, a microcatheter was gently advanced through the stent struts, and coils were delivered. Final angiographic control showed a complete occlusion of the aneurysm, and the patient was discharged 3 days later.

Patient 8

A

Discussion

This study shows that the Leo stent is a very useful tool for endovascular treatment of complex cerebral aneurysms. This stent has three major advantages: (1) two radiopaque markers along its total length make it very visible; (2) the delivery system that allows easy navigation and precise placement; and (3) the possibility to reposition the stent whenever necessary. However, the currently available stent has two relatively limiting characteristics: (1) in-stent thrombosis caused by stent

Conclusion

Our study is the largest reported single-center experience with the Leo stent. It shows that this device is a very useful tool for the treatment of complex cerebral aneurysms. This stent has three major advantages: (1) two radiopaque markers along its total length make it very visible; (2) the delivery system that allows easy navigation and precise placement; and (3) the possibility to reposition the stent whenever necessary. However, it has also two relatively limiting characteristics: (1)

Conflict of interest

We declare that we had no conflict of interest.

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