Endovascular Treatment of Ruptured Wide-Necked Anterior Communicating Artery Aneurysms Using a Low-Profile Visualized Intraluminal Support (LVIS) Device.

Gaici Xue,Jianmin Liu,Yibin Fang,Yi Xu,Qinghai Huang,Peng Liu,Fengfeng Xu,Bo Hong,Qiang Li

doi:10.3389/fneur.2020.611875

Abstract

Objective: To evaluate the safety and efficacy of low-profile visualized intraluminal support (LVIS) stent-assisted coiling for the treatment of ruptured wide-necked anterior communicating artery (ACoA) aneurysms.Methods: The clinical and angiographic data of 31 acutely ruptured wide-necked ACoA aneurysms treated with LVIS stent-assisted coiling between January 2014 and December 2018 were retrospectively reviewed.Results: All stents were successfully deployed. The immediate angiographic results were modified Raymond-Roy class I in 27 cases, modified Raymond-Roy class II in 2 cases, and modified Raymond-Roy class IIIa in 2 cases. Intraoperative thrombosis and postoperative aneurysmal rebleeding occurred in one case each. Two patients (6.5%) who were admitted due to poor clinical grade conditions died during hospital admission as a result of initial bleeding. Angiographic follow-up (mean: 12.9 months) was performed for 26 patients, the results of which demonstrated that 25 aneurysms were completely occluded and one was class II. The last clinical follow-up (mean: 25.3 months) outcomes demonstrated that 27 patients had favorable clinical outcomes and two had poor clinical outcomes.Conclusion: LVIS stent-assisted coiling for ruptured wide-necked ACoA aneurysms was safe and effective, with a relatively low rate of perioperative complications and a high rate of complete occlusion at follow-up.

Highlights

The anterior communicating artery (ACoA) is one of the most common sites of ruptured intracranial aneurysms (RIAs) [1, 2]
We present a patient cohort with ruptured wide-necked ACoA aneurysms treated with low-profile visualized intraluminal support (LVIS) stent-assisted coiling, in which we evaluated the safety and efficacy of this strategy
31 patients with 31 ruptured wide-necked ACoA saccular aneurysms treated with LVIS stent-assisted coiling, and 241 ruptured ACoA aneurysms treated with other therapies, including 12 cases with laser-cut stent-assisted coiling, 34 with balloon-assisted coiling, and 195 with simple coiling, were included

Summary

Introduction

The anterior communicating artery (ACoA) is one of the most common sites of ruptured intracranial aneurysms (RIAs) [1, 2]. Endovascular coiling of ruptured wide-necked ACoA aneurysms is still technically challenging because of the small vessel diameter, very small size, LVIS for Ruptured Aneurysms and accompanying hematoma. Our previous studies have shown that stent-assisted coiling achieved favorable outcomes in the treatment of ruptured wide-necked ACoA aneurysms [8, 9]. Compared with a non-braided stent, whether the low-profile visualized intraluminal support (LVIS) device (MicroVention, Tustin, CA, USA), which is unsuitable for the Ystent technique due to a small mesh, can be fully opened in the small-diameter vessel of the anterior communicating complex, and whether it can provide good protection to incorporating vessels is not well-reported. We present a patient cohort with ruptured wide-necked ACoA aneurysms treated with LVIS stent-assisted coiling, in which we evaluated the safety and efficacy of this strategy

Methods

Results

Conclusion