Introduction: Stent-assisted coiling has been shown to be an effective treatment modality for wide-neck intracranial aneurysms. The LVIS Jr stent (Microvention) represents a braided, re-sheathable microstent deployable via an 017 microcatheter. Complex stenting using the LVIS Jr stent is not well reported in the literature.

Methods: A retrospective analysis of patients who underwent stenting for intracranial aneurysms using LVIS Jr at a single institution was performed. Clinical and radiographic data were analyzed. A literature review was performed and data from similar series were analyzed.

Results: Twenty patients were included. Seven aneurysms were ruptured, with three treated in the acute period. Complex stenting was attempted in six patients (two Y-stenting, one X-stenting, one H-stenting, and two trans-circulation stenting), and successfully accomplished in 4 cases. One Y-stenting case was aborted due to stent migration (and retrieval), and one X-stenting case was converted to conventional stent-assisted coiling. In the entire series, clinical complications included one intraoperative rupture, one minor stroke, and one ruptured femoral artery pseudoaneurysm. The latter was the only clinical complication that occurred in a case of complex stenting. Complete occlusion immediately post-procedure was achieved in 42% of aneurysms. This improved to 86% at 3-month follow-up. One case of in-stent stenosis was observed in follow-up. 87% of patients had favorable clinical outcomes.

Conclusions: The LVIS Jr stent offers a safe and effective modality to assist in the treatment of intracranial aneurysms. Complex stenting using the LVIS Jr stent was found to be technically safe and feasible in this series.

Patient Care: Our results add to the recent body of literature detailing experience with the LVIS Jr stent in the treatment of wide-neck intracranial aneurysms. Emphasis is placed on describing preprocedural characteristics, procedural complications, and clinical outcomes associated with the use of this new device in complex stenting, which will serve to guide clinicians in making treatment decision.

Learning Objectives: o To describe patient demographics, preprocedural data, and clinical outcomes of patients who underwent stent-assisted coiling of an intracranial aneurysm using the LVIS Jr stent at a single institution. o To highlight technical details in complex stenting, defined as H-stenting, Y-stenting, and trans-circulation stenting, using the LVIS Jr stent.

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