Endovascular treatment of vertebral and basilar artery aneurysms with low-profile visualized intraluminal support device

Abstract Background The Low-profile Visualized Intraluminal Support (LVIS) device is a self-expanding, nitinol, single-braid, closed-cell device that was recently developed for endovascular embolization of intracranial aneurysms. However, current knowledge regarding the use of LVIS devices to treat vertebral and basilar artery aneurysms is limited. We aimed to evaluate the feasibility, efficacy, and safety of the LVIS device for treating vertebral and basilar artery aneurysms. Methods Between January 2015 and December 2017, patients with vertebral and basilar artery aneurysms treated using LVIS stents were enrolled in this study. We analyzed patients’ demographic, clinical and aneurysmal characteristics, procedural details, complications, and angiographic and clinical follow-up results. Results We identified 63 patients with 64 vertebral and basilar artery aneurysms who underwent treatment with (n = 59) or without (n = 5) LVIS stenting, including 10 patients with ruptured aneurysms. Forty-one aneurysms were located at the vertebral artery, and 23 at the basilar artery. Intraprocedural-related complications developed in three (4.8%) patients, while none of these patients developed morbidities or died during follow-up. Three patients developed post-procedural complications (4.8%). Two patients experienced ischemic events immediately post-procedure. A minor permanent morbidity developed in one of the two patients (1.6%). The mortality rate was 1.6%, for that the patient died of brainstem hemorrhage after 1 month of follow-up. At a mean follow-up of 12.5 months, 39/43 (90.7%) patients had stable or improved aneurysms, and four (9.3%) had recanalized. Conclusions LVIS device of vertebral and basilar artery aneurysms may be an acceptable safety profile and may represent a reasonable treatment option in the short-term. Long-term and larger cohort studies are necessary to validate our results.

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Endovascular Treatment of Vertebral and Basilar Artery Aneurysms with Low-Profile Visualized Intraluminal Support Device

10.21203/rs.3.rs-52499/v1 ◽

2020 ◽

Author(s):

Quanlong Hong ◽

Wenqiang Li ◽

Jing Ma ◽

Peng Jiang ◽

Yisen Zhang

Keyword(s):

Endovascular Treatment ◽

Basilar Artery ◽

Current Knowledge ◽

Endovascular Embolization ◽

Low Profile ◽

Closed Cell ◽

Procedural Complications ◽

Permanent Morbidity ◽

A Minor

Abstract Background: The Low-profile Visualized Intraluminal Support (LVIS) device is a self-expanding, nitinol, single-braid, closed-cell device that was recently developed for endovascular embolization of intracranial aneurysms. However, current knowledge regarding the use of LVIS devices to treat vertebral and basilar artery aneurysms is limited. We aimed to evaluate the feasibility, efficacy, and safety of the LVIS device for treating vertebral and basilar artery aneurysms.Methods: Between January 2015 and December 2017, patients with vertebral and basilar artery aneurysms treated using LVIS stents were enrolled in this study. We analyzed patients’ demographic, clinical and aneurysmal characteristics, procedural details, complications, and angiographic and clinical follow-up results.Results: We identified 63 patients with 64 vertebral and basilar artery aneurysms who underwent treatment with (n=59) or without (n=5) LVIS stenting, including 10 patients with ruptured aneurysms. Forty-one aneurysms were located at the vertebral artery, and 23 at the basilar artery. Intraprocedural-related complications developed in three (4.8%) patients, while none of these patients developed morbidities or died during follow-up. Three patients developed post-procedural complications (4.8%). Two patients experienced ischemic events immediately post-procedure. A minor permanent morbidity developed in one of the two patients (1.6%). The mortality rate was 1.6%, for that the patient died of brainstem hemorrhage after 1 month of follow-up. At a mean follow-up of 12.5 months, 39/43 (90.7%) patients had stable or improved aneurysms, and four (9.3%) had recanalized.Conclusions: Endovascular treatment of vertebral and basilar artery aneurysms with the LVIS device is feasible, safe, and effective in the short-term. Long-term and larger cohort studies are necessary to validate our results.

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Preliminary experience with the use of low profile visualized intraluminal support device in basilar artery for aneurysm treatment

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014393 ◽

2018 ◽

Vol 11 (4) ◽

pp. 405-410 ◽

Cited By ~ 1

Author(s):

Chuanchuan Wang ◽

Yina Wu ◽

Zhengzhe Feng ◽

Jing Wang ◽

Qiang Li ◽

...

Keyword(s):

Basilar Artery ◽

Mass Effect ◽

Endovascular Embolization ◽

Superior Cerebellar Artery ◽

Poor Grade ◽

Low Profile ◽

Cerebellar Artery ◽

Permanent Morbidity ◽

Occlusion Rate

BackgroundThe low profile visualized intraluminal support (LVIS) device is being increasingly used for the treatment of intracranial aneurysms. Its application in the basilar artery (BA) has not yet been reported.ObjectiveTo evaluate the safety and early efficacy of the LVIS device for the treatment of BA aneurysms.MethodsA prospectively maintained database was retrospectively reviewed for all patients with BA aneurysms treated by LVIS stents at our institution. Angiographic results were evaluated using the modified Raymond–Roy classification (mRRC).Results23 patients (mean age 52.8 years) with a BA aneurysm that was treated by LVIS stent implantation, with (n=21) or without (n=2) adjunctive coiling, were included in our study. 7 aneurysms were treated in the setting of subarachnoid hemorrhage (SAH). 10 aneurysms were located at the basilar tip, 10 at the basilar trunk, and 3 at the superior cerebellar artery. Procedure related complications developed in three patients (13%), including two perforator infarction and one worsening mass effect. Complications resulted in permanent morbidity (4%) in one case. One fatality was related to severe poor grade SAH. At a mean follow-up of 6.9 months, 13 of the 20 patients were mRRC I closure, 3 were mRRC II closure with an improvement from class IIIa, 3 were observed to be recanalized from class IIIa to IIIb, and 1 with stenting only was still patent similar to the immediate angiography.ConclusionThe LVIS stent represents a feasible and safe option for endovascular embolization of BA aneurysms. Although recanalization may occur after LVIS treatment, the mid term complete occlusion rate was acceptable.

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Neuroform Stent-Assisted Embolization of Incidental Anterior Communicating Artery Aneurysms: Long-term Clinical and Angiographic Follow-up

Neurosurgery ◽

10.1227/neu.0b013e31820edbb6 ◽

2011 ◽

Vol 69 (1) ◽

pp. 27-37 ◽

Cited By ~ 32

Author(s):

Ahmed M Raslan ◽

Murat Oztaskin ◽

Eric M Thompson ◽

Aclan Dogan ◽

Bryan Petersen ◽

...

Keyword(s):

Endovascular Embolization ◽

Long Term Results ◽

Anterior Communicating Artery ◽

Procedural Complications ◽

Aneurysm Occlusion ◽

Low Incidence ◽

Ischemic Attack ◽

Neuroform Stent

Abstract BACKGROUND: Anterior communicating artery (A-comm) aneurysm is one of the most common intracranial aneurysms. Treatments include neurosurgical clipping or endovascular embolization. OBJECTIVE: To retrospectively examine the long-term results of Neuroform stent-assisted coil embolization of incidental A-comms, with a focus on stent-associated stenosis, long-term angiographic aneurysm occlusion outcome, delayed stent-related thromboembolus, subsequent subarachnoid hemorrhage from the treated aneurysm, and procedural complications. METHODS: Between January 7, 2003 and June 16, 2009, 44 Neuroform stents were placed as an adjunct to embolization of A-comms. Patient charts were reviewed retrospectively. Angiographic follow-up of at least 3 months (up to 6.5 years, mean 65 weeks) was available for 33 patients. Aneurysm occlusion success was determined using the Raymond classification for aneurysm remnants. RESULTS: Referencing the last angiogram in the follow-up course, complete occlusion, dog-ear residual, residual neck, and residual aneurysm were found in 24, 2, 3, and 4 patients, respectively. Stenosis (45% and asymptomatic) of the artery where the stent had been placed was found in 1 patient. One patient had delayed transient ischemic attack after dual antiplatelet therapy was stopped prematurely. Retreatment based on the presence of residual aneurysm was performed or recommended in 2 patients. In 2 patients with residual or recurrent aneurysm filling, their age or clinical condition did not warrant retreatment. CONCLUSION: Neuroform stent-assisted embolization provides long-term control of A-comms with a low incidence of aneurysm growth after treatment. The need for retreatment is uncommon, and retreatment is safe if performed. Subsequent bleeding from treated aneurysms was not observed in this study.

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A Multicenter Study of Stent-Assisted Coiling of Cerebral Aneurysms With a Y Configuration

Neurosurgery ◽

10.1227/neu.0000000000000015 ◽

2013 ◽

Vol 73 (3) ◽

pp. 466-472 ◽

Cited By ~ 84

Author(s):

Kyle M. Fargen ◽

J Mocco ◽

Dan Neal ◽

Michael C. Dewan ◽

John Reavey-Cantwell ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Complication Rates ◽

Closed Cell ◽

Procedural Complications ◽

Mean Size ◽

Aneurysm Occlusion ◽

Wide Neck ◽

Grade Iii

Abstract BACKGROUND: Stent-assisted coiling with 2 stents in a Y configuration is a technique for coiling complex wide-neck bifurcation aneurysms. OBJECTIVE: We sought to provide long-term clinical and angiographic outcomes with Y-stent coiling, which are not currently established. METHODS: Seven centers provided deidentified, retrospective data on all consecutive patients who underwent stent-assisted coiling for an intracranial aneurysm with a Y-stent configuration. RESULTS: Forty-five patients underwent treatment by Y-stent coiling. Their mean age was 57.9 years. Most aneurysms were basilar apex (87%), and 89% of aneurysms were unruptured. Mean size was 9.9 mm. Most aneurysms were treated with 1 open-cell and 1 closed-cell stent (51%), with 29% treated with open-open stents and 16% treated with 2 closed-cell stents. Initial aneurysm occlusion was excellent (84% in Raymond grade I or II). Procedural complications occurred in 11% of patients. Mean clinical follow-up was 7.8 months, and 93% of patients had a modified Rankin Scale score of 0 to 2 at last follow-up. Mean angiographic follow-up was 9.8 months, and 92% of patients had Raymond grade I or II occlusion on follow-up imaging. Of those patients with initial Raymond grade III occlusion and follow-up imaging, all but 1 patient progressed to a better occlusion grade (83%; P < .05). Three aneurysms required retreatment because of recanalization (10%). There was no difference in initial or follow-up angiographic occlusion, clinical outcomes, incidence of aneurysm retreatment, or in-stent stenosis among open-open, open-closed, or closed-closed stent groups. CONCLUSION: In a large multicenter series of Y-stent coiling for bifurcation aneurysms, there were low complication rates and excellent clinical and angiographic outcomes.

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Endovascular treatment of PICA aneurysms with a Low-profile Visualized Intraluminal Support (LVIS Jr) device

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-012070 ◽

2015 ◽

Vol 8 (10) ◽

pp. 1030-1033 ◽

Cited By ~ 15

Author(s):

Edgar A Samaniego ◽

German Abdo ◽

Ricardo A Hanel ◽

Andrey Lima ◽

Santiago Ortega-Gutierrez ◽

...

Keyword(s):

Endovascular Treatment ◽

Acute Phase ◽

Posterior Inferior Cerebellar Artery ◽

Short Term ◽

Small Series ◽

Low Profile ◽

Procedural Complications ◽

Reconstructive Technique ◽

Pica Aneurysms

ObjectiveTo describe the treatment of posterior inferior cerebellar artery (PICA) aneurysms with the Low-profile Visualized Intraluminal Support Device (LVIS Jr) stent.Materials and methodsThe databases of three institutions were retrospectively reviewed. Patients who underwent endovascular treatment of PICA aneurysms using a reconstructive technique where the LVIS Jr stent was totally or partially deployed into the PICA were included in the analysis. Clinical presentation, aneurysm and PICA sizes, procedural complications, and clinical and angiographic follow-up information was recorded and analyzed.ResultsSeven patients who underwent endovascular treatment of PICA aneurysms with an LVIS Jr stent were identified. Four aneurysms were treated in the acute phase of subarachnoid hemorrhage (SAH). There were no symptomatic complications. One patient had spasm distal to the stent as a result of mechanical straightening of the vessel. One patient was treated in the acute phase of SAH and required a gycoprotein IIb/IIIa inhibitor after the stent was implanted. This patient needed to be re-treated to complete embolization. All patients had good clinical outcomes (Glasgow Outcome Scale 5). No in-stent stenosis or occlusion was seen on short-term angiographic follow-up and the aneurysms were occluded.ConclusionsThis small series suggests that the use of a reconstructive technique with the LVIS Jr stent for the treatment of PICA aneurysms is feasible, safe and effective in the short term.

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Long-term follow-up until early adulthood in autosomal dominant, complex SPG30 with a novel KIF1A variant: a case report

Italian Journal of Pediatrics ◽

10.1186/s13052-019-0752-5 ◽

2019 ◽

Vol 45 (1) ◽

Cited By ~ 3

Author(s):

Carlotta Spagnoli ◽

Susanna Rizzi ◽

Grazia Gabriella Salerno ◽

Daniele Frattini ◽

Carlo Fusco

Keyword(s):

Autosomal Dominant ◽

De Novo ◽

Current Knowledge ◽

Brain Mri ◽

Early Adulthood ◽

Cerebellar Atrophy ◽

Mild Intellectual Disability ◽

Long Term Follow Up

Abstract Background Pathogenic variants in KIF1A (kinesin family member 1A) gene have been associated with hereditary spastic paraplegia (HSP) type 30 (SPG30), encopassing autosomal dominant and recessive, pure and complicated forms. Case presentation We report the long-term follow-up of a 19 years-old boy first evaluated at 18 months of age because of toe walking and unstable gait with frequent falls. He developed speech delay, mild intellectual disability, a slowly progressive pyramidal syndrome, microcephaly, bilateral optic subatrophy and a sensory axonal polyneuropathy. Brain MRI showed cerebellar atrophy, stable along serial evaluations (last performed at 18 years of age). Targeted NGS sequencing disclosed the de novo c.914C > T missense, likely pathogenic variant on KIF1A gene. Conclusions We report on a previously unpublished de novo heterozygous likely pathogenic KIF1A variant associated with slowly progressive complicated SPG30 and stable cerebellar atrophy on long-term follow-up, adding to current knowledge on this HSP subtype.

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Long-Term Results and Follow-Up Examinations after Endovascular Embolization for Unruptured Cerebral Aneurysms

American Journal of Neuroradiology ◽

10.3174/ajnr.a6101 ◽

2019 ◽

Vol 40 (7) ◽

pp. 1191-1196 ◽

Cited By ~ 1

Author(s):

T. Murakami ◽

T. Nishida ◽

K. Asai ◽

Y. Kadono ◽

H. Nakamura ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Endovascular Embolization ◽

Long Term Results ◽

Unruptured Cerebral Aneurysms

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Ruptured basilar artery perforator aneurysms—treatment regimen and long-term follow-up in eight cases

Neuroradiology ◽

10.1007/s00234-015-1634-1 ◽

2015 ◽

Vol 58 (3) ◽

pp. 285-291 ◽

Cited By ~ 14

Author(s):

Robert Forbrig ◽

Bernd Eckert ◽

Lorenz Ertl ◽

Maximilian Patzig ◽

Christian Brem ◽

...

Keyword(s):

Treatment Regimen ◽

Basilar Artery ◽

Long Term Follow Up ◽

Artery Perforator

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Long-term catheter angiography after aneurysm coil therapy: results of 209 patients and predictors of delayed recurrence and retreatment

Journal of Neurosurgery ◽

10.3171/2014.7.jns132433 ◽

2014 ◽

Vol 121 (5) ◽

pp. 1102-1106 ◽

Cited By ~ 31

Author(s):

Nohra Chalouhi ◽

Cory D. Bovenzi ◽

Vismay Thakkar ◽

Jeremy Dressler ◽

Pascal Jabbour ◽

...

Keyword(s):

Diagnostic Yield ◽

Cerebral Aneurysms ◽

Short Term ◽

Unruptured Intracranial Aneurysms ◽

Long Term Follow Up ◽

Major Shortcoming ◽

Male Sex ◽

A Minor

Object Aneurysm recurrence after coil therapy remains a major shortcoming in the endovascular management of cerebral aneurysms. The need for long-term imaging follow-up was recently investigated. This study assessed the diagnostic yield of long-term digital subtraction angiography (DSA) follow-up and determined predictors of delayed aneurysm recurrence and retreatment. Methods Inclusion criteria were as follows: 1) available short-term and long-term (> 36 months) follow-up DSA images, and 2) no or only minor aneurysm recurrence (not requiring further intervention, i.e., < 20%) documented on short-term follow-up DSA images. Results Of 209 patients included in the study, 88 (42%) presented with subarachnoid hemorrhage. On shortterm follow-up DSA images, 158 (75%) aneurysms showed no recurrence, and 51 (25%) showed minor recurrence (< 20%, not retreated). On long-term follow-up DSA images, 124 (59%) aneurysms showed no recurrence, and 85 (41%) aneurysms showed recurrence, of which 55 (26%) required retreatment. In multivariate analysis, the predictors of recurrence on long-term follow-up DSA images were as follows: 1) larger aneurysm size (p = 0.001), 2) male sex (p = 0.006), 3) conventional coil therapy (p = 0.05), 4) aneurysm location (p = 0.01), and 5) a minor recurrence on short-term follow-up DSA images (p = 0.007). Ruptured aneurysm status was not a predictive factor. The sensitivity of short-term follow-up DSA studies was only 40.0% for detecting delayed aneurysm recurrence and 45.5% for detecting delayed recurrence requiring further treatment. Conclusions The results of this study highlight the importance of long-term angiographic follow-up after coil therapy for ruptured and unruptured intracranial aneurysms. Predictors of delayed recurrence and retreatment include large aneurysms, recurrence on short-term follow-up DSA images (even minor), male sex, and conventional coil therapy.

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