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Research ArticleInterventional

Periprocedural Safety and Feasibility of the New LVIS EVO Device for Stent-Assisted Coiling of Intracranial Aneurysms: An Observational Multicenter Study

D.F. Vollherbst, A. Berlis, C. Maurer, L. Behrens, S. Sirakov, A. Sirakov, S. Fischer, V. Maus, M. Holtmannspötter, R. Rautio, M. Sinisalo, W. Poncyljusz, H. Janssen, F. Wodarg, C. Kabbasch, J. Trenkler, C. Herweh, M. Bendszus and M.A. Möhlenbruch
American Journal of Neuroradiology February 2021, 42 (2) 319-326; DOI: https://doi.org/10.3174/ajnr.A6887

Article Figures & Data

Figures

  • FIG 1.
    FIG 1.

    Stent-assisted coiling of an incidental aneurysm of the AcomA. DSA (A) and 3D reconstructions of rotational angiography (B and C) show a wide-neck aneurysm of the AcomA. After positioning of a microcatheter within the aneurysm (black arrow in D), a 3 × 18 mm LVIS EVO stent was deployed in the A1 and A2 segments of the left ACA (stent ends marked with white arrows). Shouldering of the stent at the base of the aneurysm (black arrowheads) enabled protection of the aneurysmal neck. Subsequently, the aneurysm was coiled (E and F). The shouldered stent enabled complete protection of the parent artery at the aneurysmal neck (black arrows in E) and remodeling of the parent artery. DSAs after treatment (G–I) show complete occlusion of the aneurysm.

  • FIG 2.
    FIG 2.

    Stent-assisted coiling of an incidental aneurysm of the basilar artery. Digital subtraction angiography (A and B) and 3D reconstructions of rotational angiography (C) show a wide-neck aneurysm of the tip of the basilar artery. After positioning of a microcatheter within the aneurysm, a Headway 17 microcatheter was positioned in the left posterior cerebral artery via the right posterior cerebral artery (black arrow in D), the right posterior communicating artery, and the right ICA. Subsequently, a 2.5 × 17 mm LVIS EVO stent (distal end marked with a white arrow in D) was deployed horizontally over the aneurysmal neck, followed by coiling of the aneurysm (E and F). The stent ensured protection and remodeling of the parent artery (white arrow in G and H). DSAs after treatment (F, H, and I) show complete occlusion of the aneurysm.

Tables

  • Table 1:

    Patient and aneurysm characteristics

    CharacteristicDataa
    Age (yr)58.5 [SD, 12.0] (25–81)
    Clinical presentationIncidental (n = 34) (57.6%), recanalization (n = 7) (11.9%), SAH (n = 9) (15.3%), symptomaticb (n = 5) (8.5%), ischemic strokec (n = 2) (3.4%), residual aneurysm (n = 2) (3.4%)
    Aneurysm locationMCA (n = 15) (25.4%), AcomA (n = 13) (22.0%), BA (n = 9) (15.3%), ICA (n = 7) (11.9%), ACA (n = 6) (10.2%), Others (n = 9) (15.3%)
    Aneurysm size (maximal diameter) (mm)6.2 [SD, 3.9 ] (1.0–18.0)
    Aneurysm typeSaccular (n = 55) (93.2%), dissecting (n = 3) (5.1%), blisterlike (n = 1) (1.7%)
    Neck diameter (mm)4.2 [SD, 1.8] (1.0–9.5)
    Dome-to-neck ratio1.5 [SD, 0.7] (0.3–4.5)
    Diameter of the parent artery proximal to the aneurysm (mm)2.8 [SD, 0.8 ] (1.0–4.3 )
    Diameter of the parent artery distal to the aneurysm (mm)2.4 [SD, 0.8]  (1.2–4.0)
    Angulation of the parent artery at the site of the aneurysm102.6° [SD, 44.1°] (23.0°–180.0°)

    • ↵a Data are mean [SD] (minimum to maximum) or absolute number of cases (relative frequency in %).

    • ↵b Symptoms not caused by SAH or ischemic stroke, including headaches (n = 3), dizziness (n = 1). and double vision (n = 1).

    • ↵c Related to the aneurysm.

  • Table 2:

    Treatment characteristics, safety, and feasibility

    Characteristics, Safety, and Feasibilitya
    Treatment parameter
     Reason for choosing LVIS EVOWide neck(n = 56) (94.9%)Flow diversion (n = 2) (3.4%)Bailout (n = 1) (1.7%)
     Ease of deploymentVery poor (n = 0) (0%)Poor (n = 0) (0%)Intermediate (n = 0) (0%)Good (n = 4) (6.8%)Very good (n = 55) (93.2%)
     RadiopacityVery poor (n = 0) (0%)Poor (n = 0) (0%)Intermediate(n = 1) (1.7%)Good (n = 28) (47.5%)Very good (n = 30) (50.8%)
     Treatment techniqueJailing technique (n = 52) (88.1%)WEB and stent (n = 3) (5.1%)Stent only (n = 2) (3.4%)Coiling passing through stent (n = 2) (3.4%)
    Safety
     Technical complicationsThrombus formation (n = 3) (5.1%)Stent shortening (n = 1) (1.7%)Incomplete stent opening (n = 1) (1.7%)Coil protrusion (n = 1) (1.7%)Unrelated to LVIS EVO (n = 1) (1.7%)
     Clinical complicationsbTIA (n = 2) (3.4%)Major strokec(n = 1) (1.7%)Minor stroked(n = 1) (1.7%)GIT bleeding (n = 1) (1.7%)Leg ischemia (n = 1) (1.7%)Puncture side bleeding(n = 1)(1.7%)
    Feasibility
     Occlusion immediately after treatmenteI: Complete occlusion (n = 32) (54.2%)II: Residual neck (n = 6) (10.2%)IIIa: Residual neck with contrast within coil interstices (n = 18) (30.5%)IIIb: Residual neck with contrast along aneurysm wall(n = 3) (5.1%)

    • Note:—GIT indicates gastrointestinal tract.

    • ↵a Data are mean [SD], (minimum to maximum), or absolute number of cases (relative frequency in %).

    • ↵b Two patients had 2 clinical complications, respectively.

    • ↵c Not related to the intervention (most likely caused by vasospasm).

    • ↵d Related to the intervention (stroke in vascular territory of stented artery).

    • ↵e Reported according to the modified Raymond-Roy classification.

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Periprocedural Safety and Feasibility of the New LVIS EVO Device for Stent-Assisted Coiling of Intracranial Aneurysms: An Observational Multicenter Study
D.F. Vollherbst, A. Berlis, C. Maurer, L. Behrens, S. Sirakov, A. Sirakov, S. Fischer, V. Maus, M. Holtmannspötter, R. Rautio, M. Sinisalo, W. Poncyljusz, H. Janssen, F. Wodarg, C. Kabbasch, J. Trenkler, C. Herweh, M. Bendszus, M.A. Möhlenbruch
American Journal of Neuroradiology Feb 2021, 42 (2) 319-326; DOI: 10.3174/ajnr.A6887
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