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  • Low-Profile Visualized Intraluminal Support Device (LVIS Jr) for the Treatment of Intracranial Aneurysms

    Final Number:
    1100

    Authors:
    Mihir Gupta, MD; Peter Abraham, BA; David Rafael Santiago-Dieppa, MD; Vincent J. Cheung, MD; Abdulrahman Almansouri; J. Scott Pannell, MD;Alexander A. Khalessi, MD, MS, FAHA, FAANS

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Early case series suggest that the recently introduced Low-Profile Visualized Intraluminal Support Device (LVIS Jr) may be used to treat wide-necked aneurysms that would otherwise require treatment with intra-saccular devices or open surgery. We report the first North American single-center experience utilizing LVIS Jr to treat intracranial aneurysms involving 1.8-2.5mm parent arteries.

    Methods: We retrospectively examined patients with ruptured, incidental or recurrent aneurysms treated with the LVIS Jr stent over a one-year period. Aneurysms were treated by stent-assisted coiling (SAC) or stand-alone stent placement. Angiographic occlusion was graded by consensus scale for SAC, or expanded Raymond-Roy score for flow diversion. Good functional outcome was defined as Modified Rankin score = 2.

    Results: A total of 21 aneurysms were treated in 18 patients. Aneurysms were 2-25mm in diameter; one was ruptured, while three had recurred after previous rupture and treatment. Lesions were distributed across the anterior (n=12) and posterior (n=9) circulations. Three were fusiform morphology. Stent deployment was successful in 100% of cases with no immediate complications. Seventeen aneurysms were treated with SAC, with immediate complete occlusion in 94.1%. Only one case required further treatment: a fusiform dissecting aneurysm treated with elective clip ligation after delayed extension (Figure 1). Four aneurysms were treated by flow diversion, and complete occlusion was achieved in three cases (Figure 2). Small foci of delayed ischemic injury were noted in two patients: one was asymptomatic, and another experienced transient deficits in the setting of medication noncompliance. No in-stent stenosis, migration, hemorrhage, or permanent deficits were observed. Good functional outcome was achieved in 100% of cases.

    Conclusions: Our experience suggests that the LVIS Jr stent may be used for a variety of intracranial aneurysms involving small parent arteries, with excellent angiographic and clinical outcomes. Future studies may build upon our experiences with flow diversion and treatment of complex lesions.

    Patient Care: This series demonstrates that the LVIS Jr stent may be used for a variety of intracranial aneurysms involving small parent arteries, with excellent angiographic and clinical outcomes. Our experiences form a platform for further studies of LVIS Jr for flow diversion and treatment of complex lesions.

    Learning Objectives: • The LVIS Jr stent may be used to treat a variety of intracranial aneurysms involving small parent arteries that would otherwise require treatment with intra-saccular devices or open surgical clipping. • Early experiences suggest that the LVIS Jr device may be used for stand-alone treatment by flow diversion of aneurysms in selected cases.

    References: 1. Behme D, Weber A, Kowoll A, Berlis A, Burke TH, Weber W. Low-profile Visualized Intraluminal Support device (LVIS Jr) as a novel tool in the treatment of wide-necked intracranial aneurysms: initial experience in 32 cases. Journal of neurointerventional surgery. 2015;7(4):281-285. 2. Cekirge HS, Saatci I. A New Aneurysm Occlusion Classification after the Impact of Flow Modification. AJNR. American journal of neuroradiology. 2016;37(1):19-24. 3. Cho YD, Sohn CH, Kang HS, et al. Coil embolization of intracranial saccular aneurysms using the Low-profile Visualized Intraluminal Support (LVIS) device. Neuroradiology. 2014;56(7):543-551. 4. Feng Z, Li Q, Zhao R, et al. Endovascular Treatment of Middle Cerebral Artery Aneurysm with the LVIS Junior Stent. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2015;24(6):1357-1362. 5. Feng Z, Zhang L, Li Q, et al. Endovascular treatment of wide-neck anterior communicating artery aneurysms using the LVIS Junior stent. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2015;22(8):1288-1291. 6. Meyers PM, Schumacher HC, Higashida RT, et al. Reporting standards for endovascular repair of saccular intracranial cerebral aneurysms. Journal of neurointerventional surgery. 2010;2(4):312-323. 7. Poncyljusz W, Bilinski P, Safranow K, et al. The LVIS/LVIS Jr. stents in the treatment of wide-neck intracranial aneurysms: multicentre registry. Journal of neurointerventional surgery. 2015;7(7):524-529. 8. Samaniego EA, Abdo G, Hanel RA, Lima A, Ortega-Gutierrez S, Dabus G. Endovascular treatment of PICA aneurysms with a Low-profile Visualized Intraluminal Support (LVIS Jr) device. Journal of neurointerventional surgery. 2015.

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