Application of LVIS stent in endovascular treatment of acutely ruptured intracranial wide-necked aneurysms

Abstract

Objective To evaluate the safety and efficacy of LVIS stent-assisted embolization of acutely ruptured intra-cranial wide-necked aneurysms. Methods Forty-eight patients with acutely ruptured intracranial wide-necked aneurysms treated with LVIS stent-assisted embolization at Department of Neurosurgery, Heze Municipal Hospital from January 2014 to June 2016 were enrolled into this study. The clinical data, procedure-related complications, embolization rate of aneurysms, imaging follow-up results and clinical outcomes of the 48 patients were analyzed retrospectively. Results The stents of 48 patients were released completely (100%). Raymond grade I embolization was achieved in 25 cases (52.1%), Raymond grade Ⅱ embolization in 18 cases (37.5%), and Raymond grade Ⅲ embolization in 5 cases (10.4%). Four patients had in-stent thrombosis including 2 cases occurring in the process of embolization and 2 occurring within 24 hours post embolization.Following treatment with tirofiban hydrochloride, the thrombosis disappeared and permanent hemiplegia remained in 1 patient. Incomplete stent expansion was seen in 1 patient and improved after dilatation by balloon. Two aneurysms ruptured in the operation and were secured by subsequent coiling. Among the 39 (81.2%) patients who underwent angiographic follow-up lasting 6-11 months (mean: 7.8±3.6 months), 35 (89.7%) patients gained complete occlusion, 3(7.7%), 3 aneurysms were stable and 1 (2.6%) reported recurrence of aneurysm. No rebleeding occurred in all aneurysms at the 6-month follow-up. Thirty-eight patients had good outcome (modified Rankin scale, mRS: 0-2), 8 reported poor effect (mRS: 3-5), and the rate of good outcome was 82.6%. Conclusions Application of LVIS stent-assisted embolization of acutely ruptured intracranial wide-necked aneurysms is suggested to be safe and feasible. Further research is needed to determine the long-term stability of stents after embolization. Key words: Aneurysm, ruptured; Stents; Embolization, therapeutic; Treatment outcome