E-048 Low profile visible intraluminal support device LVIS JR in the treatment of complex intracranial aneurysms

Abstract

Endovascular treatment of wide-necked intracranial aneurysms has proven difficult with standard coil embolization. Balloon remodelling or stent-assisted coiling have been introduced to improve the likelihood of successful coil embolization of intracranial aneurysms with complex angioarchitecture. Stent technology is rapidly evolving, and one of the newest stents available is the Low profile Visualized Intraluminal Support device (LVIS Jr, Microvention-Terumo). The purpose of this study was to evaluate the efficacy and safety of deployment of LVIS Jr stent in the treatment of complex/wide-neck intracranial saccular aneurysms. Methods A retrospective analysis was conducted on 65 patients treated at Hamilton Health Sciences, McMaster University from January 2014 to April 2018 using an LVIS Jr stent device for saccular aneurysm treatment. All clinical and radiological data were analyzed with follow-up of 0–36 months. Results Preliminary analysis revealed a mean age of 58.7 years (range 25–75) with 38 subjects (58.5%) being female. Aneurysm characteristics were as follows: 21/65 (32.3%) were ruptured, and 42/65 (64.6%) where in the anterior cerebral circulation. In all cases, LVIS Jr stent was successfully deployed in small caliber parent vessels (1.1–2.5 mm) with very low rates of intra-procedural aneurysm rupture 3/65. Neurological and non-neurological complications occurred in 13/65 patients, 6 patients with small non-disabling ischemic infarcts, and two patients developed a retroperitoneal hematoma. There was one case of hyperacute in-stent thrombosis treated with intra-arterial abciximab without ischemic infarction and one case of delayed in-stent thrombosis with minor ischemic infarction. There was one case of delayed in-stent stenosis without infarction. One patient died 5 days after stent-assisting coiling secondary to ICH. Occlusion rates for treated aneurysms were complete in 23/65 (35.3%) and near complete in 24/65 (36.9%) with very low rates of aneurysm recanalization. Conclusion Endovascular treatment of complex, wide-necked, intracranial saccular aneurysms with a stent-assisted approach using the LVIS Jr stent is both safe and effective. Disclosures M. Alwadai: None. N. Alharbi: None. E. Mazidi: None. C. Fong: None. A. Martyniuk: None. A. Algird: None. R. Larrazabal: None. B. van Adel: None.