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; Objective To investigate the safety and efficacy of Lvis stent in the treatment of intracranial wide-necked microaneurysms. Methods From May 2016 to May 2018, 54 consecutive patients with intracranial wide-necked microaneurysms and were treated with Lvis stent-assisted coiling embolization at Department of Neurosurgery, Sichuan Provincial People's Hospital were recruited. The clinical data and treatment outcomes were retrospectively analyzed. Raymond classification was used to evaluate the results of aneurysm embolization immediately after intervention and 6 to 12 months after interventioa Regular clinical follow-up was conducted at 1, 3, 6 and 12 months after intervention, and every year thereafter. Reexamination by DSA was performed at 6 to 12 months after surgery to evaluate aneurysm embolization, stent displacement, stent stenosis, etc. The modified Rankin scale (mRS) score was used to evaluate the prognosis. Results Lvis stent-assisted coiling embolization were all successfully performed in 54 patients. Immediate postoperative embolization results of 54 aneurysms; Raymond classification I in 49 cases (90. 7%); Raymond classification II in 5 cases (9. 3%). Complete stent expansion was in 53 patients and incomplete in 1 patient. Forty-there patients received DSA follow-up at 6-12 months after interventions, with Raymond classification I in 42 cases (97. 7%) and classification II in 1 case (2. 3%). Fifty-four cases had clinical follow-ups without recurrent bleeding, death or disability. The mRS score was 0 in 52 cases and 1 in 2 cases. None of the 54 patients had any stroke during the follow-up periods. Conclusions Lvis stent-assisted coiling embolization is safe and effective in the treatment of intracranial wide-necked microaneurysm. The long-term efficacy remains to be confirmed by larger studies with longer follow-up duration.
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Objective To analyze the angiographic results of intracranial aneurysms without complete embolization immediately after low-profile visualized intraluminal support device (LVIS) stent at mid-term follow up,and explore the risk factors for healing of partial occluded aneurysms.Methods One hundred and sixty-one patients with intracranial aneurysms treated by LVIS stent embolization in our hospital from December 2014 to December 2018 were selected;193 aneurysms in total,including 93 un-ruptured aneurysms and 100 ruptured aneurysms,were noted.DSA was performed immediately after operation to evaluate the degrees of aneurysm embolization according to Raymond grading criteria.The embolization degrees of aneurysms were compared at 8 months after surgery and immediately after surgery,and the healing of aneurysms (Raymond grading 1) was calculated.Univariate Logistic regression analysis and multivariate Logistic regression analysis (forward maximum likelihood ratio method) were used to screen the risk factors for healing of incomplete aneurysm embolization.Results The embolization degrees immediately after surgery were as follows:78 were with Raymond grading 1,54 with Raymond grading 2,and 61 with Raymond grading 3;complete aneurysm embolization were noted in 78 aneurysms (40.41％) and incomplete aneurysm embolization were noted in 115 (59.59％).Follow up (8 months after surgery) results indicated that,of the 193 aneurysms,171 were with Raymond grading 1,10 with Raymond grading 2,and 12 with Raymond grading 3;there were 171 aneurysms (88.60％) having complete aneurysm embolization and 22 (11.40％) having incomplete aneurysm embolization.In the aneurysms having incomplete aneurysm embolization immediately after surgery,the healing rate was 81.74％ (94/115).Univariate Logistic regression analysis showed that hypertension,diabetes mellitus,posterior circulation aneurysm,dissecting aneurysm,body-neck ratio and embolization degrees immediately after surgery were risk factors for healing of aneurysms (P＜0.05).Multivariate Logistic regression analysis revealed that posterior circulation aneurysm and diabetes mellitus were independent risk factors for healing of aneurysms (P＜0.05).The area under the curve of receiver operating characteristic curve of the regression model was 0.755,indicating that the prediction efficiency of the regression model was moderate.Conclusion Treatment of intracranial aneurysms with LVIS stent is effective,and the complete occlusion rate is high,even in the aneurysms with incomplete embolization immediately after surgery;aneurysms located in the posterior circulation and associated with diabetes can affect the treatment of aneurysms.
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Objective To investigate the safety and efficacy of LVIS stent combined with coil embolization of ruptured wide-necked intracranial aneurysms during the acute phase.Methods From May 2014 to August 2017,the clinical and imaging data of 56 patients with ruptured wide-necked intracranial aneurysm treated with LVIS stents for acute phase assisted embolization at the Department of Neurosurgery,the Affiliated Hospital of Southwest Medical University were analyzed retrospectively.All patients were treated with LVIS stent combined with coil embolization.Immediate postoperative angiography,six months after procedure,and follow-up imaging were evaluated by Raymond grade (RS grade).The clinical follow-up results were evaluated by the modified Rankin Scale (mRS) score.Results LVIS stent combined with coil embolization was performed in 56 patients with 60 aneurysms in this group.The success rate of stent release was 100％.Immediate angiography after procedure showed that the complete embolization rate of aneurysms was 80.0％ (48/60),the near complete embolization rate was 13.3 ％ (8/60),and the incomplete embolization rate was 6.7％ (4/60).Postoperative follow-up angiography at 6 monthrevealed that the complete embolization rate of aneurysms was 87.8％ (36/41),nearly complete embolization rate was 7.3％ (3/41),incomplete embolization rate was 4.9％ (2/41).Postoperative follow-up angiography at 12 months revealed that the complete embolization rate of aneurysms was 83.0％ (39/47),and near complete embolization rate was 12.8％ (6/47),and incomplete embolization rate was 4.3％ (2/47).Of the 56 patients,49 were followed up clinically and 7 were lost to follow up.The average follow-up time was 13 ± 4 months.The clinical follow-up showed that the good prognosis (mRS score 0-2) rate was 87.8％ (43/49).Intraoperative complications occurred in 7 cases,5 were intraoperative parent artery thrombosis and 2 were intraoperative aneurysm rupture.Conclusions LVIS stent combined with coil embolization of ruptured wide-necked intracranial aneurysms during the acute phase has good efficacy and safety.Its long-term efficacy remains to be confirmed by long-term follow-up.
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Objective To summarize operation experiences in applying microcoils embolization for the treatment of intracranial wide-necked aneurysms using the low-profile visualized intraluminal stent support (LVIS) in elderly patients.Methods We reviewed data of 47 elderly patients (48 aneurysms) with intracranial wide-necked aneurysms treated with LVIS stent-assisted microcoils embolization.Results Forty-seven aneurysms were embolized successfully,one stent was withdrawn because its midpiece failed to stretch.Instant Raymond classifications evaluation after the surgery showed Grade Ⅰ in 52.1％ (25/48 aneurysms),Grade Ⅱ in 37.5％ (18/48 aneurysms),and Grade Ⅲ in 8.3 ％ (4/48 aneurysms).Besides,the effective rate of aneurysms embolization was 91.5 ％.During 3 to 12-month follow-up with digital subtraction angiography (DSA) in 36 patients (36 aneurysms),mRS was scored 0 (best effectiveness) in 28 cases,scored 1 in 4 cases,scored 2 in 3 cases,and scored 3 in 1 case,and the total favorable rate was 97％.Conclusions LVIS stent-assisted microcoils embolization for the treatment of intracranial wide-necked aneurysms in elderly patients may avoid or reduce the incidence of complication.
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Objective To investigate the effect of vascular tortuosity and bending radius on the new type knitting stents (LVIS stent ) releasing on the cavernous sinus segment of internal carotid artery. Methods From December 2015 to January 2016,31 consecutive patients with wide-neckedaneurysm treated with LVIS stents and the proximal end of the stent released in the cavernous segment at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were enrolled. According to whether the stents completely adhered to the walls or not after the first release,they were divided into two groups:a satisfactorily release group (n =23 )or an unsatisfactorily release group (n =8 ). The differences of vascular tortuosity and bending radius of the 2 groups were compared.Results Thevascular tortuosities of the satisfactorily release group and the unsatisfactorily release group were 118° ± 23° and 147° ± 19° respectively. There was significant difference (P=0. 028). The vascular bending radii were 3. 4 ± 0. 7 mm and 2. 8 ± 0. 7 mm respectively. There was significant difference (P=0. 042). The mean vascular tortuosity was larger and the mean vascular bending radius was smaller in the unsatisfactorily release group. Conclusions The greater the vascular tortuosity,the smaller the vascular bending radius may be connected with the unsatisfactorily release in the LVIS stent. The evaluation of vascular tortuosity is conductive to the guidance of the stent release technique before stent implantation.
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Objective To investigate the safety and short-term efficacy for evaluation of the low-profile visualized intraluminal support device (LVIS stents )compression and lantern release shapes for the treatment of wide-necked intracranial aneurysms. Methods From December 2014 to October 2015,15 patients with intracranial wide-neck aneurysm (16 aneurysms)received LVIS stent treatment, whose stent shapes had shortening changes were analyzed retrospectively. Thecompression mode refers to the length of LVIS stent to be shorter for more than 5 mm than the label release value by operation. Thelantern mode refers to the widened diameter of LVIS stent at the neck of aneurysm. The metal coverage rate in the posterior communicating segment of internal carotid artery after stent compression was calculated, and its safety and efficacy were assessed immediately after procedure and at 3 months after procedure. Results (1 )Using LVIS stent-assisted treatment,16 wide-necked aneurysms were treated,including 8 posterior communicating aneurysms,6 ophthalmic aneurysms,one anterior choroidal artery aneurysm and one M2 bifurcation fusiform aneurysm. The aneurysm neck was 1. 8 to 8. 0 mm (mean 3. 9 ± 1. 7 mm). A total of 15 LVIS stents were implanted (one patient with 2 aneurysms were treated with 1 stent). All the stents were released by using compression mode,and 4 of the patients (4 stents)also used the lantern mode at the same time. (2 ) After LVIS stenting,the Raymond grade Ⅰ embolization was in 10 aneurysms (62.5%),the covered branch arteries were patent immediately after procedure. (3)No perioperative technology-related hemorrhagic and ischemic complications occurred. The success rate of stent implantation was 100%(15/15). (4)The metal coverage rate after stent compression in the internal carotid artery posterior communicating segment was 30. 3%-38. 5%(mean 35. 0 ± 2. 8%). (5)After LVIS stent implantation,15 patients were followed up by whole brain DSA for 3 to 5 months (mean 3. 2 ± 0. 5), 14 aneurysms were cured on imaging (Raymond gradeⅠ),and no aneurysm recurred. All branch arteries covered by the stents did not have vascular occlusion. There was no in-stent restenosis or parent artery occlusion. The total disability rate was 6. 7%(1/15),and no patient died. Conclusions LVIS stents can increase aneurysm neck metal coverage rate and short-term cure rate throughcompression andlantern modes,while does not affect the covered branches. Choosing the appropriate cases for thelanternmode may be beneficial to the short-term protection of the vascular branches at the aneurysm necks.
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Objective To explore the application value of L VIS stetu in interventional treatment of intracranial wide-necked small aneurysms,and evaluate its safety and effectiveness.Methods A total of 11 patients with intracranial wide-necked small aneurysms,admitted to and received LVIS stent-assisted coil embolization in our hospital trom November 2014 to June 2015,were chosen in our study.Their clinical data and treatment effects were retrospectively analyzed.Results All operations were successful in 11 patients;11 LVIS stents were deployed;Raymond classification right after the surgery hinted grade Ⅰ in 4 aneurysms,grade Ⅱ in 5 aneurysms,and grade in in 2 aneurysms.There were 2 patients enjoying suboptimal opening ofLVIS stents.Raymond classification 6 months after the surgery hinted grade Ⅰ in 8 aneurysms and grade Ⅱ in one aneurysm.Modified Rankin scale 6 months after the surgery indicated that 10 patients had 0 point and one patient had 2 points.Conclusion The LVIS stent is safe and effective for treatment of intracranial wide-necked small aneurysms;short-term effect is good;the technique requirements of stetu releases are relatively high and require more attention of clinicians.