Low-Profile Visualized Intraluminal Support Stent for the Endovascular Treatment of Traumatic Internal Carotid Artery Pseudoaneurysms

Objectives Optimal treatment strategies for traumatic internal carotid artery (ICA) pseudoaneurysms are controversial. The low-profile visualized intraluminal support (LVIS) device is a braided stent with a metal coverage rate between traditional laser cut stents and flow diversion devices. We report here our therapy strategy using the LVIS stent-assisted coiling for treatment of traumatic ICA pseudoaneurysms.Methods Patients with traumatic ICA pseudoaneurysms treated by the LVIS stent-assisted coiling in our center between January 2015 to June 2021 were reviewed. The complications, radiographic, and clinical outcomes of these patients were analyzed.Results A total of 12 pseudoaneurysms in 12 patients were included. Immediate postoperative angiogram showed that six (50%) aneurysms were Raymond grade 1, four (33.3%) were grade 2, and two (16.7%) were grade 3. Two patients with severe primary cranial injury discontinued treatment after the procedure. During the follow-up of the other ten patients, two patients (20%) received additional coiling because of recanalization of the pseudoaneurysm. At the last angiographic follow-up examination, all aneurysms were Raymond grade 1. Postoperative multiple cerebral infarction occurred in two patients. Of the ten patients with a mean clinical follow-up of 32.2 ± 27.9 (median, 18) months, eight patients recovered well, one patient had right hemiplegia, and one patient died of airway damage, which was unrelated to the pseudoaneurysm.Conclusions LVIS stent-assisted coiling was a feasible approach for the treatment of traumatic ICA pseudoaneurysms.

A braided stent becomes flattened inside a curved catheter tube: A micro-CT imaging study

BACKGROUND: The braided stent is a widely accepted endovascular treatment device consisting of woven metal wires. One of the unsolved issues for the braided stent is the stent flattening phenomena when deployed into highly curved arteries. Although a recent computational study highlighted that the mechanical state of the stent inside the catheter before the deployment plays an essential role in causing stent flattening, there is no experimental observation for the stent inside the curved catheter. OBJECTIVE: We investigated braided stent shapes in curved catheter tubes with various curvatures by micro-computed tomography (CT). METHODS: A braided stent was deployed into catheter tubes and set in rectangular cases with constant curvature. The three-dimensional shape of the stent was imaged by micro-CT, and its cross-sectional flatness was quantitatively assessed. RESULTS: Stent flattening occurred in cases of high curvatures of the outer side of the tube curvature, and the degree of flatness increased with increasing tube curvature. This demonstrates that stent flattening can be caused inside the highly curved catheter before deployment. CONCLUSIONS: This preliminary and first observational report provides new insight into the mechanism of stent flattening and emphasizes the importance of the geometrical and mechanical state of the stent inside the catheter.

Low-Profile Visualized Intraluminal Support Jr Braided Stent Versus Atlas Self-Expandable Stent for Treatment of Intracranial Aneurysms: A Single Center Experience

BACKGROUND The Neuroform Atlas Stent and Low-profile Visualized Intraluminal Support (LVIS) and LVIS Jr stents are used to treat intracranial aneurysms (IAs), but their safety, performance, and outcomes have not been directly compared. OBJECTIVE To compare the technical performance and outcomes of Atlas and LVIS Jr stents for treatment of IAs. METHODS IAs treated by stent-assisted coiling using an Atlas (Stryker, Kalamazoo, Michigan) or LVIS Jr (MicroVention, Aliso Viejo, California) device between January 2014 to November 2019 were retrospectively evaluated. Patient demographics, aneurysm size and location, technical difficulties, and clinical and angiographic follow-up were analyzed. RESULTS A total of 116 patients, (mean age 64.2 ± 11.8 yr, 72.7% female) with 121 aneurysms underwent stent-assisted coiling with deployment of Atlas (n = 64) or LVIS Jr (n = 57) stents. Mean aneurysm size was 6.2 ± 2.7 mm. Immediate rates of Raymond-Roy (RR) 1/2 were 89.0% (57/64) and 80.7% (46/57) for the Atlas and LVIS Jr groups, respectively. Neither group had major postoperative thromboembolic complications; however, 15.8% (9/57) of the LVIS Jr procedures had technical issues. Additionally, 88.5% (46/52) and 91.2% (33/36) of patients in the Atlas and LVIS Jr groups had RR 1/2 at a mean follow-up of 13.6 and 18.7 mo, respectively. CONCLUSION Treatment of IAs with Atlas and LVIS Jr stents results in favorable clinical outcomes and angiographic results at follow-up, with low rates of recurrence and retreatment, suggesting both devices are safe and effective. Notably, LVIS Jr had more technical problems than Atlas.

Follow-up outcomes of intracranial aneurysms treated using braided or laser-cut stents with closed-cell design: a propensity score-matched case-controlled comparison

BackgroundThe impact of various stents on patients with intracranial aneurysms who undergo stent-assisted coiling has been debated. We conducted this study to compare follow-up outcomes of coiling procedures involving braided or laser-cut stents with closed-cell design. A propensity score-matched case-controlled analysis was applied.MethodsA total of 413 intracranial aneurysms consecutively coiled using laser-cut (n=245) or braided stents (n=168) in procedures performed between September 2012 and June 2017 were eligible for study. Time-of-flight magnetic resonance angiography, catheter angiography, or both were used to gauge occlusive status after coiling. Recanalization was determined by Raymond classification (complete occlusion vs recanalization). A propensity score-matched analysis was conducted, based on probability of stent type in use.ResultsUltimately, 93 coiled aneurysms (22.5%) showed some recanalization (minor, 51; major, 42) during the follow-up period (mean 21.7±14.5 months). Patient gender (P=0.042), hyperlipidemia (P=0.015), size of aneurysm (P=0.004), neck size (P<0.001), type of aneurysm (P<0.001), and packing density (P=0.024) differed significantly by group. Midterm and cumulative recanalization incidence rates in the braided-stent group were initially lower than those of the laser-cut stent group (P=0.009 and P=0.037, respectively) but they did not differ significantly after 1:1 propensity score matching (midterm OR=0.88, P=0.724; cumulative HR=0.91, P=0.758).ConclusionIn stent-assisted coiling of intracranial aneurysms, laser-cut and braided stent groups produced similar outcomes in follow-up. Consequently, product selection may hinge on suitability for deployment rather than anticipated results.