Initial Experience with LVIS EVO Stents for the Treatment of Intracranial Aneurysms

Background: Over the years, a variety of intracranial stents have been developed, which has expanded the therapy options available for cerebral aneurysms. The Low profile visible intraluminal support (LVIS) EVO stents are new devices, which officially appeared on the market in 2020. The purpose of the study is to report the initial technical and clinical experience with the new stent in the treatment of intracranial aneurysms. Materials and Methods: Between February and September 2020, 30 patients with 35 intracranial aneurysms (29 unruptured and 6 ruptured) were treated using the LVIS EVO stent in our department. The aneurysms were located within internal carotid artery (ICA) (42.9%), middle cerebral artery (MCA) (31.4%), anterior communicating artery (AComA) (11.4%), basilar artery (BA) (11.4%) and anterior cerebral artery (ACA) (2.9%). Stent-assisted coil embolization was performed in all cases. Results: All stents were deployed successfully in the desired position. Immediate complete occlusion of the treated aneurysms, described as Raymond–Roy occlusion classification (RROC) class 1, was achieved in all cases. No technical complications were observed. One thromboembolic complication occurred in the group of unruptured aneurysms and one patient died due to cerebral edema from aneurysms rupture group. Conclusion: In our observation, the showed a satisfactory safety profile LVIS EVO stents seem to be very flexible, can be safely maneuvered and deployed in tortuous vessels. They showed a good initial occlusion rate when used for treating intracranial aneurysms with SAC (stent-assisted coiling).

Download Full-text

Delineation of unruptured cerebral aneurysms by computerized angiotomography

Journal of Neurosurgery ◽

10.3171/jns.1982.57.4.0527 ◽

1982 ◽

Vol 57 (4) ◽

pp. 527-534 ◽

Cited By ~ 21

Author(s):

Syoji Asari ◽

Toru Satoh ◽

Masaru Sakurai ◽

Yuji Yamamoto ◽

Kazuhiko Sadamoto

Keyword(s):

Cerebral Artery ◽

Internal Carotid ◽

Cerebral Aneurysms ◽

Sylvian Fissure ◽

Anterior Communicating Artery ◽

Basal Cistern ◽

Content Type ◽

Unruptured Aneurysms ◽

Iodine Level ◽

Unruptured Cerebral Aneurysms

✓ Unruptured aneurysms were diagnosed in 15 of 86 patients with cerebral aneurysms during 2 years beginning in April, 1979. One patient with severe head injury was excluded from the series. Fifteen aneurysms in the other 14 patients were first detected by computerized angiotomography. Six aneurysms were located in the middle cerebral artery, three in the upper half of the basilar artery, two in the anterior communicating artery, two in the posterior cerebral artery, and two at the internal carotid-posterior communicating artery junction (both in the same patient). Three were smaller than 5 mm, eight were between 6 and 10 mm, and four were larger than 10 mm. The noncontrast-enhanced computerized tomography (CT) findings associated with 15 aneurysms were as follows: five showed defects in the basal cistern or Sylvian fissure, four were calcified or high-density masses, and in six instances there was no evidence of an aneurysm. Unruptured aneurysms may be suggested by a well demarcated, round, isodense mass which forms a defect in the basal cistern or Sylvian fissure on a plain CT image, and are highly and homogeneously enhanced by computerized angiotomography. A carotid artery blood iodine level of 15 mg/ml is required to obtain clear images. The authors conclude that computerized angiotomography is useful in the delineation of unruptured aneurysms.

Download Full-text

The incidence and treatment of asymptomatic, unruptured cerebral aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1994.80.2.0217 ◽

1994 ◽

Vol 80 (2) ◽

pp. 217-223 ◽

Cited By ~ 170

Author(s):

Toshio Nakagawa ◽

Kazuo Hashi

Keyword(s):

Early Detection ◽

Internal Carotid ◽

Cerebral Aneurysms ◽

Maximum Diameter ◽

Anterior Communicating Artery ◽

Content Type ◽

Unruptured Aneurysms ◽

Unruptured Intracranial Aneurysms ◽

History Of ◽

Unruptured Cerebral Aneurysms

✓ The importance of early detection by various radiological techniques of asymptomatic, unruptured aneurysms as a means of preventing subarachnoid hemorrhage (SAH) is discussed in this report. Four hundred volunteers underwent clinical and radiological evaluations between March, 1988, and September, 1992. Studies included a neurological examination as well as digital subtraction cerebral angiography via a femoral arterial catheter, computerized tomography, T1- and T2-weighted magnetic resonance (MR) imaging of the whole brain, and MR angiography. The evaluation revealed 27 asymptomatic, unruptured intracranial aneurysms in 26 volunteers, for an incidence of 6.5%. The subjects ranged in age from 39 to 71 years, with an average of 55 years. The aneurysms were located on the internal carotid artery in 13 cases (48%), the anterior communicating artery in six (22%), the middle cerebral artery in six (22%), and the basilar artery in two (7%). Aneurysms ranged in size from 5 mm or less in 16 cases, 6 to 10 mm in nine, and 11 to 15 mm in one; one aneurysm was more than 15 mm, with a maximum diameter of 2 cm. Volunteers with a family history of SAH within the second degree of consanguinity showed a higher incidence of aneurysms (17.9%). Aneurysm clipping was performed on 20 of the 26 cases with no significant morbidity or mortality. These findings support the contention that aggressive early detection of unruptured aneurysms may improve the outcome in patients harboring cerebral aneurysms by preventing the devastating effects of SAH.

Download Full-text

Prevalence of Unruptured Intracranial Aneurysms: A Single Center Experience using 3T Brain MR Angiography

Neurointervention ◽

10.5469/neuroint.2021.00024 ◽

2021 ◽

Author(s):

Jae Ho Kim ◽

Kyung-Yul Lee ◽

Sang Woo Ha ◽

Sang Hyun Suh

Keyword(s):

Magnetic Resonance ◽

Cerebral Artery ◽

Intracranial Aneurysms ◽

Internal Carotid ◽

Anterior Communicating Artery ◽

Health Examination ◽

Single Center ◽

Single Center Experience ◽

Institutional Review ◽

Unruptured Intracranial Aneurysms

Purpose: The purpose of this study was to evaluate the prevalence and risk factors of unruptured intracranial aneurysms (UIAs), which can help establish guidelines of treatment for asymptomatic Korean adults using 3T magnetic resonance angiography (MRA).Materials and Methods: Our Institutional Review Board approved this retrospective study, and informed consent was waived. All patients consisted of healthy individuals who underwent brain MRA using 3T magnetic resonance imaging between January 2011 and December 2012 as part of a routine health examination. Patient data and follow-up results were obtained from medical records.Results: A total of 2,118 individuals (mean age=53.9±9.6 years, male:female=1,188:930) who had undergone brain MRA were enrolled in the study. UIAs were found in 80 patients with 105 UIAs (3.77%). Female predominance (55% in UIA versus 43.47% in non-UIA, P=0.0416) and hypertension were more common in the UIA group (43.75% <i>vs</i>. 28.8%, P=0.004, respectively). The mean size of the aneurysms was 3.10±1.62 mm, and they were all saccular in shape and asymptomatic. The UIAs were most common in the internal carotid artery (59.1%), internal carotid-posterior communicating artery (15.2%), middle cerebral artery (9.5%), anterior communicating artery (8.6%), anterior cerebral artery (4.8%), and vertebral artery (2.9%). Twenty-eight of 80 patients (35%) had multiple aneurysms. The incidence of UIAs increased significantly with age (P=0.014).Conclusion: In single center experience, we demonstrated the characteristics and prevalence of UIAs in asymptomatic adults, which may help establish guidelines or therapeutic standards for UIAs.

Download Full-text

Use of Distal Intracranial Catheters for Better Working View of Cerebral Aneurysms Hidden by Parent Artery or Its Branches: A Technical Note

Neurointervention ◽

10.5469/neuroint.2021.00269 ◽

2021 ◽

Author(s):

Ehab Mahmoud ◽

Samuel Lenell ◽

Christoffer Nyberg ◽

Ljubisa Borota

Keyword(s):

Endovascular Treatment ◽

Internal Carotid ◽

Cerebral Aneurysms ◽

Technical Note ◽

Parent Artery ◽

Endovascular Techniques ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Class 1 ◽

Procedural Outcomes

A good working view is critical for safe and successful endovascular treatment of cerebral aneurysms. In a few cases, endovascular treatment of cerebral aneurysms may be challenging due to difficulty in obtaining a proper working view. In this report of 6 cases, we described the advantage of using a distal intracranial catheter (DIC) to achieve better visualization of cerebral aneurysms hidden by a parent artery or its branches. Between September 2017 and January 2021, we treated 390 aneurysms with endovascular techniques. In 6 cases in which it was difficult to obtain a proper working view, the DIC was placed distally close to the aneurysm in order to remove the parent artery projection from the working view and obtain better visualization of the aneurysm. Clinical and procedural outcomes and complications were evaluated. The position of the DIC was above the internal carotid artery siphon in the 6 cases. All aneurysms were successfully embolized. Raymond–Roy class 1 occlusion was achieved in all 4 unruptured aneurysms, while the result was class 2 in the 2 ruptured aneurysms. Placement of the DIC was atraumatic without dissections or significant catheter-induced vasospasm in all patients. Transient dysphasia was seen in 2 cases and transient aphasia in 1. Using this technique, we have found it possible to better visualize the aneurysm sac or neck and thereby treat cases we otherwise would have considered untreatable.

Download Full-text

Early postmarket results with PulseRider for treatment of wide-necked intracranial aneurysms: a multicenter experience

Journal of Neurosurgery ◽

10.3171/2019.5.jns19313 ◽

2020 ◽

Vol 133 (6) ◽

pp. 1756-1765 ◽

Cited By ~ 1

Author(s):

Visish M. Srinivasan ◽

Aditya Srivatsan ◽

Alejandro M. Spiotta ◽

Benjamin K. Hendricks ◽

Andrew F. Ducruet ◽

...

Keyword(s):

Cerebral Artery ◽

Intracranial Aneurysms ◽

Aneurysm Rupture ◽

Anterior Communicating Artery ◽

Parent Vessel ◽

Aneurysm Neck ◽

Off Label ◽

Fda Approval ◽

Class 1

OBJECTIVETraditionally, stent-assisted coiling and balloon remodeling have been the primary endovascular treatments for wide-necked intracranial aneurysms with complex morphologies. PulseRider is an aneurysm neck reconstruction device that provides parent vessel protection for aneurysm coiling. The objective of this study was to report early postmarket results with the PulseRider device.METHODSThis study was a prospective registry of patients treated with PulseRider at 13 American neurointerventional centers following FDA approval of this device. Data collected included clinical presentation, aneurysm characteristics, treatment details, and perioperative events. Follow-up data included degree of aneurysm occlusion and delayed (> 30 days after the procedure) complications.RESULTSA total of 54 aneurysms were treated, with the same number of PulseRider devices, across 13 centers. Fourteen cases were in off-label locations (7 anterior communicating artery, 6 middle cerebral artery, and 1 A1 segment anterior cerebral artery aneurysms). The average dome/neck ratio was 1.2. Technical success was achieved in 52 cases (96.2%). Major complications included the following: 3 procedure-related posterior cerebral artery strokes, a device-related intraoperative aneurysm rupture, and a delayed device thrombosis. Immediately postoperative Raymond-Roy occlusion classification (RROC) class 1 was achieved in 21 cases (40.3%), class 2 in 15 (28.8%), and class 3 in 16 cases (30.7%). Additional devices were used in 3 aneurysms. For those patients with 3- or 6-month angiographic follow-up (28 patients), 18 aneurysms (64.2%) were RROC class 1 and 8 (28.5%) were RROC class 2.CONCLUSIONSPulseRider is being used in both on- and off-label cases following FDA approval. The clinical and radiographic outcomes are comparable in real-world experience to the outcomes observed in earlier studies. Further experience is needed with the device to determine its role in the neurointerventionalist’s armamentarium, especially with regard to its off-label use.

Download Full-text

Superciliary Keyhole Approach for Small Unruptured Aneurysms in Anterior Cerebral Circulation

Operative Neurosurgery ◽

10.1227/neu.0b013e3182124810 ◽

2011 ◽

Vol 68 (suppl_2) ◽

pp. ons300-ons309 ◽

Cited By ~ 6

Author(s):

Jaechan Park ◽

Hyunjin Woo ◽

Dong-Hun Kang ◽

Joo-Kyung Sung ◽

Yongsun Kim

Keyword(s):

Intracranial Aneurysms ◽

Internal Carotid ◽

Control Group ◽

Anterior Communicating Artery ◽

Consecutive Series ◽

Pterional Approach ◽

Unruptured Aneurysms ◽

Operative Duration ◽

Unruptured Intracranial Aneurysms ◽

Keyhole Approach

Abstract Background: Neurovascular surgeons have been trying to find a solution to the problem of surgical invasiveness by applying minimally invasive keyhole approaches. Objective: To evaluate the feasibility and surgical outcomes of a superciliary keyhole approach for unruptured intracranial aneurysms (UIAs) as an alternative to a pterional approach. Methods: The authors report on a consecutive series of patients who underwent a superciliary approach for clipping UIAs smaller than 15 mm arising at the supraclinoid internal carotid artery (ICA), A1 segment, anterior communicating artery (ACoA), and M1 segment including the middle cerebral artery (MCA) bifurcation. The data were compared with a historical control group (n = 90) who underwent a pterional approach for UIAs. Results: A total of 120 aneurysms were successfully clipped in 102 patients with a mean age of 58 years. There was no direct mortality related to the surgery, and only 1 (1.0%) patient developed significant morbidity adversely affecting the Glasgow Outcome Scale score. The superciliary approach demonstrated statistically significant advantages over the pterional approach, including a shorter operative duration (mean, 120 min), no intraoperative blood transfusion, and extremely rare postoperative epidural hemorrhages. In addition, temporalis atrophy was rare and palsy of the frontalis persisting more than 6 months only occurred in 6 patients (5.9%) and was resolved within 2 years. The overall cosmetic outcome was excellent. Conclusion: A superciliary approach can be a reasonable alternative to a pterional approach for small (<15 mm) UIAs arising at the supraclinoid ICA, A1, ACoA, and M1 segment including the MCA bifurcation.

Download Full-text

The Medina Embolic Device: early clinical experience from a single center

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012539 ◽

2016 ◽

Vol 9 (1) ◽

pp. 77-87 ◽

Cited By ~ 28

Author(s):

Marta Aguilar Perez ◽

Pervinder Bhogal ◽

Rosa Martinez Moreno ◽

Hansjörg Bäzner ◽

Oliver Ganslandt ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Internal Carotid ◽

Clinical Status ◽

Anterior Communicating Artery ◽

Major Step ◽

Unruptured Aneurysms ◽

True Value ◽

Unruptured Intracranial Aneurysms ◽

Flow Diverters

ObjectiveTo report our initial experience with the Medina Embolic Device (MED) in unruptured intracranial aneurysms either as sole treatment or in conjunction with additional devices.Methods15 consecutive patients (6 women, 9 men) with unruptured aneurysms were treated between September 2015 and April 2016. The aneurysm fundus measured at least 5 mm. We evaluated the angiographic appearances of treated aneurysms at the end of the procedure and at follow-up, the clinical status, complications, and requirement for adjunctive devices.ResultsThe MED was successfully deployed in all but one case and adjunctive devices were required in 10 cases. Aneurysm locations were middle cerebral artery bifurcation (n=3), internal carotid artery (ICA) bifurcation (n=1), supraclinoid ICA (n=5), posterior communicating artery (n=1), anterior communicating artery (n=2), cavernous ICA (n=2), distal basilar sidewall (n=1), basilar tip (n=1). Three patients had complications although none could be attributed to the MED. Immediate angiographic results were modified Raymond-Roy classification (mRRC) I=1, mRRC II=5, mRRC IIIa=3, mRRC IIIb=5, and one patient showed contrast stasis within the fundus of the aneurysm. Follow-up angiography was available in 11 patients, with four showing complete aneurysm exclusion, six with stable remnants and one patient with an enlarging neck remnant.ConclusionsThe MED represents a major step forward in the treatment of intracranial aneurysms. It can result in rapid exclusion of an aneurysm from the circulation and has a good safety profile. We believe that the true value of the MED will be in combining its use with adjunctive devices such as endoluminal flow diverters that will result in rapid aneurysmal exclusion.

Download Full-text

Characteristics of Unruptured Compared to Ruptured Intracranial Aneurysms: A Multicenter Case–Control Study

Neurosurgery ◽

10.1093/neuros/nyx365 ◽

2017 ◽

Vol 83 (1) ◽

pp. 43-52 ◽

Cited By ~ 10

Author(s):

Isabel C Hostettler ◽

Varinder S Alg ◽

Nichole Shahi ◽

Fatima Jichi ◽

Stephen Bonner ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Artery ◽

Intracranial Aneurysms ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Anterior Communicating Artery ◽

Imaging Data ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Multivariable Analyses ◽

Different Characteristics

Abstract BACKGROUND Only a minority of intracranial aneurysms rupture to cause subarachnoid hemorrhage. OBJECTIVE To test the hypothesis that unruptured aneurysms have different characteristics and risk factor profiles compared to ruptured aneurysms. METHODS We recruited patients with unruptured aneurysms or aneurysmal subarachnoid hemorrhages at 22 UK hospitals between 2011 and 2014. Demographic, clinical, and imaging data were collected using standardized case report forms. We compared risk factors using multivariable logistic regression. RESULTS A total of 2334 patients (1729 with aneurysmal subarachnoid hemorrhage, 605 with unruptured aneurysms) were included (mean age 54.22 yr). In multivariable analyses, the following variables were independently associated with rupture status: black ethnicity (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.29-4.56, compared to white) and aneurysm location (anterior cerebral artery/anterior communicating artery [OR 3.21; 95% CI 2.34-4.40], posterior communicating artery [OR 3.92; 95% CI 2.67-5.74], or posterior circulation [OR 3.12; 95% CI 2.08-4.70], compared to middle cerebral artery). The following variables were inversely associated with rupture status: antihypertensive medication (OR 0.65; 95% CI 0.49-0.84), hypercholesterolemia (0.64 OR; 95% CI 0.48-0.85), aspirin use (OR 0.28; 95% CI 0.20-0.40), internal carotid artery location (OR 0.53; 95% CI 0.38-0.75), and aneurysm size (per mm increase; OR 0.76; 95% CI 0.69-0.84). CONCLUSION We show substantial differences in patient and aneurysm characteristics between ruptured and unruptured aneurysms. These findings support the hypothesis that different pathological mechanisms are involved in the formation of ruptured aneurysms and incidentally detected unruptured aneurysms. The potential protective effect of aspirin might justify randomized prevention trials in patients with unruptured aneurysms.

Download Full-text

Small ruptured and unruptured complex cerebral aneurysms: Single center experience of low-profile visualized intraluminal support stent

Journal of Neurorestoratology ◽

10.26599/jnr.2019.9040025 ◽

2019 ◽

Vol 07 (04) ◽

pp. 235-241

Author(s):

Xianli Lv ◽

Chuhan Jiang ◽

Shikai Liang

Keyword(s):

Intracranial Aneurysms ◽

Internal Carotid ◽

Cerebral Aneurysms ◽

Clinical Results ◽

Single Center Experience ◽

Low Profile ◽

Aneurysm Embolization ◽

Complete Obliteration ◽

Bleeding History

Objectives:Even though low-profile visualized intraluminal support (LVIS) device is used extensively currently and provide intraluminal support in complex cerebral aneurysm embolization, only few studies have reported its clinical results. This study presents the results of patients treated with LVIS.Patients and methods:Cerebral aneurysms with an undefined neck, fusiform shape, and blood blister-like aneurysms that were treated with LVIS between May 2017 and May 2019 were reviewed retrospectively.Results:Overall, 112 aneurysms in 104 patients were treated using LVIS, and 105 LVISs were placed. Of these, 101 aneurysms (90%) were small (< 10 mm) in size, 17 were fusiform aneurysms, and 3 were blood blister-like aneurysms. Overall, 39 patients suffered a subarachnoid hemorrhage and 65 had no bleeding history. 2 patients died of internal carotid artery (ICA) thrombosis, resulting in 1.9% mortality rate. Follow-up angiography was obtained in 68 patients (65%), and the complete obliteration rate was 98.5% in 6–12 months.Conclusion:The LVIS is a safe and effective treatment for small ruptured or unruptured complex intracranial aneurysms.

Download Full-text

Staged Approach for Stent-Assisted Coiling of Cerebral Aneurysms after Failure of Initial Intra-Saccular Catheterization

Neurointervention ◽

10.5469/neuroint.2020.00374 ◽

2021 ◽

Vol 16 (1) ◽

pp. 46-51

Author(s):

Abdulrahman Hamad Al-Abdulwahhab ◽

Deok Hee Lee ◽

Yunsun Song ◽

Dae Chul Suh

Keyword(s):

Internal Carotid ◽

Cerebral Aneurysms ◽

Superior Cerebellar Artery ◽

Unruptured Aneurysms ◽

Low Profile ◽

Cerebellar Artery ◽

Feasible Option ◽

Staged Approach ◽

The Mean

Purpose: Microcatheter navigation into an aneurysm sac can present difficulties through negative interactions between the deployed stent mesh and microcatheter. We hypothesized that endothelialization of the stent mesh would minimize these interactions. We aimed to assess the feasibility of staged coiling after stenting by reviewing our experiences with unavoidably staged embolization cases.Materials and Methods: Between 2011 and 2019, 7 patients (mean age 57.2 years, range 49–76 years) including 5 females, experienced 9 unruptured aneurysms treated with staged stenting and coiling due to unstable microcatheter navigation into the aneurysm after stent placement. The aneurysms were in the paraclinoid internal carotid artery (ICA) (n=3), ophthalmic origin ICA (n=1), superior cerebellar artery origin (n=2), basilar tip (n=2), and the middle cerebral artery bifurcation (n=1). The stents used were the Neuroform Atlas (n=4), Neuroform EZ (n=2), and Low-profile Visualized Intraluminal Support Blue (n=1).Results: The mean interval between stenting and coiling was 15 weeks (range, 12–21 weeks). The average navigation time between the first roadmap imaging and microcatheter insertion in the sac was 14 minutes (range, 8–20 minutes). One aneurysm was occluded without further coiling on follow-up. Staged coiling successfully treated the remaining aneurysms (n=8). No complications were identified.Conclusion: In cases of difficult intra-saccular catheterization, intentional staged coiling may be a feasible option for stent-assisted coiling of the cerebral aneurysms.

Download Full-text