Introduction: Basilar tip aneurysms (BTA), have a higher probability of rupture, with poorer outcomes, and remain difficult to treat. Recanalization at the neck is common. Traditional stent-assisted techniques use stents to prevent coil mass herniation. We describe a LVIS Jr. stent technique (Microvention, CA) in a “loaded” configuration that acted as both scaffold for embolization and lead to partial neck obliteration.
Methods: A 63-year old male with un-ruptured wide-neck giant BTA, previously partially treated, presented with obstructive hydrocephalus and stroke from recanalization. After shunt placement, stent-assisted embolization occurred. The LVIS Jr. was deployed from the left PCA into the basilar with “loading” of the stent during deployment to create a pillowed, barrel configuration at the aneurysm neck. Embolization was completed through the stent lattice.
Results: This “loaded” LVIS Jr. stent technique lead to partial obliteration of the aneurysm neck and created a durable scaffold to prevent dense coil mass migration. The end result was 98% obliteration of the aneurysm.
Conclusions: Here we describe a “loading” technique used to create the functional effect of combining stent-assisted embolization with balloon remodeling techniques in BTA. This technique capitalizes on the inherent properties of the LVIS Jr.’s lattice and compliant cell design.
Patient Care: Developing technologies for neuro-vascular treatment should continue to compel interventionalists to seek novel ways of deploying technology for the treatment of complex aneurysms.
Learning Objectives: 1) Inherent physical properties of the LVIS Jr stent allow for use out of traditional "tube" stent configurations to treat wide-neck aneurysms.
2) Using different stent deployment techniques, the interventionalist can preferentially shape the stent to aid in wide-neck aneurysm obliteration