Endovascular treatment for tiny ruptured intracranial aneurysms is known to be technically challenging. Thus, we aimed to investigate the safety and efficacy of low-profile visualized intraluminal support (LVIS) stents in the treatment of tiny ruptured intracranial aneurysms.
Methods
From April 2014 to June 2019, among 90 patients with tiny ruptured aneurysms who were treated at our institution endovascularly, 28 underwent stent-assisted coiling with LVIS stents. The clinical and angiographic results were reviewed.
Results
In the LVIS group, complete occlusion was achieved in 27 patients (96.4%). Intraprocedural thrombus formation occurred in 3 patients (10.7%). Follow-up angiography in 24 patients at 6–12 months showed complete occlusion in 23 patients (95.8%) and no aneurysm recurrence. In the coiling-only group, complete occlusion was achieved in 58 patients (93.5%). Intraprocedural aneurysm rupture occurred in 2 patients (3.2%), and postprocedural ischemia occurred in 4 patients (6.5%), with a complication rate of 9.7%. Follow-up angiography in 52 patients at 6–12 months showed complete occlusion in 43 patients (82.7%) and aneurysm recurrence in 7 patients (9.2%). No significant (p > 0.05) differences existed between the two groups.
Conclusions
The LVIS stent is safe and effective in the treatment of tiny ruptured intracranial aneurysms.
BakkerNAVeegerNJVan DijkJM. ISAT: end of the debate on coiling versus clipping?Lancet2015; 385: 2251.
2.
LutherEMcCarthyDJBrunetMC, et al.Treatment and diagnosis of cerebral aneurysms in the post-international Subarachnoid Aneurysm Trial (ISAT) era: trends and outcomes. J Neurointerv Surg2020; 12: 682–687. DOI: 10.1136/neurintsurg-2019-015418
3.
KimBJKangHGKwunBD, et al.Small versus large ruptured intracranial aneurysm: concerns with the site of aneurysm. Cerebrovasc Dis2017; 43: 139–144.
4.
TaiJLiuJLvJ, et al. Risk factors predicting a higher grade of subarachnoid haemorrhage in small ruptured intracranial aneurysm (< 5 mm). Neurol Neurochir Pol2019; 53: 296–303.
5.
GrassoGPerraG. Surgical management of ruptured small cerebral aneurysm: outcome and surgical notes. Surg Neurol Int2015; 6: 85.
6.
MitchellPJMuthusamySDowlingR, et al. Does small aneurysm size predict intraoperative rupture during coiling in ruptured and unruptured aneurysms?J Stroke Cerebrovasc Dis2013; 22: 1298–1303.
7.
AnokwuteMCBracaJABohnstedtB, et al. Endovascular treatment of ruptured tiny (3 mm) intracranial aneurysms in the setting of subarachnoid hemorrhage: a case series of 20 patients and literature review. J Clin Neurosci2017; 40: 52–56.
8.
WangJWLiCHTianYY, et al. Safety and efficacy of endovascular treatment of ruptured tiny cerebral aneurysms compared with ruptured larger aneurysms. Interv Neuroradiol2020; 26: 283–290. DOI: 10.1177/1591019919897446.
9.
GaoBLiTLiL, et al. Tiny cerebral aneurysms Can Be treated safely and effectively with low-profile visualized intraluminal support stent-assisted coiling or coiling alone. World Neurosurg2018; 113: e426–e430. DOI: 10.1016/j.wneu.2018.02.051.
10.
WuPOcakPWangD, et al. Endovascular treatment of ruptured tiny intracranial aneurysms with low-profile visualized intraluminal support device. J Stroke Cerebrovasc Dis2019; 28: 330–337. DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.052.
11.
FangYBWenWLYangPF, et al. Long-term outcome of tubridge flow diverter(S) in treating large vertebral artery dissecting aneurysms-A pilot study. Clin Neuroradiol2017; 27: 345–350.
12.
RaymondJKlinkRChagnonM, et al. Hydrogel versus bare platinum coils in patients with large or recurrent aneurysms prone to recurrence after endovascular treatment: a randomized controlled trial. AJNR Am J Neuroradiol2017; 38: 432–441.
13.
WiebersDO. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. The Lancet2003; 362: 103–110.
14.
YamakiVNBrinjikjiWMuradMH, et al. Endovascular treatment of very small intracranial aneurysms: meta-analysis. AJNR Am J Neuroradiol2016; 37: 862–867.
15.
GuptaMCheungVAbrahamP, et al. Low-profile visualized intraluminal support junior device for the treatment of intracranial aneurysms. Cureus2017; 9: e1037. DOI: 10.7759/cureus.1037.
16.
LimJWLeeJChoYD. Progressive occlusion of small saccular aneurysms incompletely occluded after stent-assisted coil embolization : analysis of related factors and long-term outcomes. Clin Neuroradiol2018; 28: 569–577.
17.
FooMMaingardJHallJ, et al. Endovascular treatment of intracranial aneurysms using the novel Low profile visualized intraluminal support EVO stent: multicenter early feasibility experience. Neurointervention2021; 16: 122–131.
18.
PoncyljuszWKubiakK. Initial experience with LVIS EVO stents for the treatment of intracranial aneurysms. J Clin Med2020; 9: 3966–3974. DOI: 10.3390/jcm9123966.
19.
HanelRAKallmesDFLopesDK, et al. Prospective study on embolization of intracranial aneurysms with the pipeline device: the PREMIER study 1 year results. J Neurointerv Surg2020; 12: 62–66.
20.
ChalouhiNStarkeRMYangS, et al. Extending the indications of flow diversion to small, unruptured, saccular aneurysms of the anterior circulation. Stroke2014; 45: 54–58.
21.
BhogalPHenkesESchobS, et al. The use of flow diverters to treat small (≤ 5 mm) ruptured, saccular aneurysms. Surg Neurol Int2018; 9: 216. DOI: 10.4103/sni.sni_243_18.
22.
HanelRAAguilar-SalinasPBrasilienseLBC, et al. First US experience with pipeline flex with shield technology using aspirin as antiplatelet monotherapy. BMJ Case Rep2017; 2017: 1–5. DOI: 10.1136/bcr-2017-219406.
23.
Lenz-HabijanTBhogalPPetersM, et al. Hydrophilic stent coating inhibits platelet adhesion on stent surfaces: initial results In vitro. Cardiovasc Intervent Radiol2018; 41: 1779–1785.
24.
StarkeRMChalouhiNAliMS, et al. Endovascular treatment of very small ruptured intracranial aneurysms: complications, occlusion rates and prediction of outcome. J Neurointerv Surg2013; 5 : iii66-71.
25.
BrinjikjiWLanzinoGCloftHJ, et al. Endovascular treatment of very small (3 mm or smaller) intracranial aneurysms: report of a consecutive series and a meta-analysis. Stroke2010; 41: 116–121.
26.
NguyenTNRaymondJGuilbertF, et al. Association of endovascular therapy of very small ruptured aneurysms with higher rates of procedure-related rupture. J Neurosurg2008; 108: 1088–1092.
27.
DamianoRJTutinoVMPaliwalN, et al. Aneurysm characteristics, coil packing, and post-coiling hemodynamics affect long-term treatment outcome. J Neurointerv Surg2019: 1–8. DOI: 10.1136/neurintsurg-2019-015422.
28.
RaymondJGhostineJvan AdelBA, et al. Does increasing packing density using larger caliber coils improve angiographic results of embolization of intracranial aneurysms at 1 year: a randomized trial. AJNR Am J Neuroradiol2020; 41: 29–34.
29.
LimayeKZanatyMHudsonJ, et al. The safety and efficacy of continuous tirofiban as a monoantiplatelet therapy in the management of ruptured aneurysms treated using stent-assisted coiling or flow diversion and requiring ventricular drainage. Neurosurgery2019; 85: E1037–E1042.
30.
PeretAMineBBonnetT, et al. Safety and efficacy of a pre-treatment antiplatelet regimen of unruptured intracranial aneurysms: a single-center experience. Neuroradiology2020; 62: 1029–1041. DOI: 10.1007/s00234-020-02387-y.
31.
BondKMBrinjikjiWMuradMH, et al. Diffusion-Weighted imaging-detected ischemic lesions following endovascular treatment of cerebral aneurysms: a systematic review and meta-analysis. AJNR Am J Neuroradiol2017; 38: 304–309.
32.
KikuchiTIshiiAChiharaH, et al. Occlusion Status on magnetic resonance angiography Is associated with risk of delayed ischemic events in cerebral aneurysms treated with stent-assisted coiling. World Neurosurg2017; 107: 226–232.
