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ObjectiveIn the study, we explored the safety and effectiveness of staged stenting strategy for acutely wide-neck ruptured intracranial aneurysms.MethodsOnline databases, including PubMed, EMBASE, the Cochrane database, and Web of Science, were retrospectively and systematically searched. The main observation indicators were the procedure-related complication rate, complete occlusion rate, and favorable clinical outcome. Meta-analysis was performed using a random or fixed effect model based on heterogeneity.ResultsA total of 5 studies with 143 patients were included. The hemorrhagic complication rate of the initial coiling and staged stenting was 2.8% (4 of 143) and 0, respectively. The ischemic complication rate of the coiling and supplemental stenting was 3.5% (5 of 143) and 2.9% (4 of 139), respectively. There were no deaths due to procedure-related complications in two stages. The aneurysm complete occlusion rate was 25% (95% CI, 0.13–0.03; I2 = 4.4%; P = 0.168) after initial coiling, 54% (95% CI, 0.63–0.64; I2 = 0%; P = 0.872) after staged stenting, and 74% (95% CI, 0.66–0.81; I2 = 56.4%; P = 0.562) at follow-up, respectively. Favorable clinical outcome rate 74% (95% CI, 0.61–0.86; I2 = 50.5%; P = 0.133) after discharge of initial coiling treatment, and 86% (95% CI, 0.80–0.92; I2 = 0; P = 0.410) after discharge from stenting, and 97% (95% CI, 0.93–1.01; I2 = 43.8%; P = 0.130) at follow-up.ConclusionStaged stenting treatment of wide-neck RIA with coiling in the acute phase followed by delayed regular stent or flow-diverter stent had high aneurysm occlusion rate, favorable clinical outcome rate and low procedure-related complication rate. A more dedicated and well-designed controlled study is warranted for further evaluation of staged stenting treatment compared to SCA in wide-neck RIA.

PurposeThis study aimed at investigating a novel standby microwire technique to facilitate revascularization of large vessel occlusion due to underlying long-segment dissection.MethodsPatients with acute ischemic stroke with emergent large vessel occlusion (ELVO) due to underlying long-segment dissection were screened from the prospectively established database between January 2021 and May 2022. The clinical and radiological data of eligible patients who underwent endovascular treatment by using a standby microwire technique were investigated.ResultsOf the 165 acute ischemic stroke patients who underwent mechanical thrombectomy, the standby microwire technique was used in five patients aged 33–55 years old with occlusion due to underlying long-segment dissection. Of them, three patients were diagnosed with tandem lesions and three were located at the anterior circulation. A 300 cm exchange microwire was used as the standby microwire. Stent deployment was performed in all five patients. Groin puncture to reperfusion time ranged from 10–68 min. Technical success and favorable clinical outcomes were achieved in all five patients (100%). No technique-related complication was observed.ConclusionOur preliminary experience showed that the standby microwire technique was a useful ancillary approach to facilitate the revascularization of large vessel occlusion due to underlying long-segment dissection.

To compare the safety and efficacy of low profile visualized intraluminal support (LVIS) stent-assisted hydrogel coil embolization and LVIS stent-assisted bare platinum coil embolization for acutely ruptured wide-necked intracranial.89 patients who underwent LVIS stent-assisted hydrogel coil embolization (hydrogel coil group) and 145 patients who underwent LVIS stent-assisted bare platinum coil embolization (platinum coil group) were retrospectively reviewed after 1:2 propensity score matching (PSM). Procedure-related complications, clinical and angiographic follow-up outcomes were compared between the two groups.All baseline characteristics were equivalent between hydrogel coil group and platinum coil group after PSM. There were no statistical differences in immediate postoperative embolization results, clinical and angiographic follow-up outcomes between the two groups (P = 0.514, P = 0.323 and P = 0.949, respectively). Intraprocedural aneurysm rupture, intraprocedural thrombosis and postprocedural thrombosis occurred in 2 patients (2.2%, 2/89), 1 patient (1.1%, 1/89) and 1 patient (1.1%, 1/89) of the hydrogel coil group compared with 1 patient (0.7%, 1/145), 1 patient (0.7%, 1/145) and 2 patients (1.4%, 2/145) of the platinum coil group, respectively (P = 0.559, P = 1.000 and P = 1.000). Nevertheless, the rate of postprocedural aneurysm early rebleeding in the hydrogel coil group was significantly lower than that in the platinum coil group (0.0% vs 4.8%, P = 0.046).LVIS stent-assisted hydrogel coil embolization may reduce the risk of aneurysm early rebleeding compared with LVIS stent-assisted bare platinum coil embolization for the treatment of acutely ruptured wide-necked intracranial aneurysms, which implies that hydrogel coil may improve the safety of stent placement for ruptured intracranial aneurysms.

BACKGROUND Low-profiled visualized intraluminal support (LVIS) is suggested as a promising stent for complex intracranial aneurysms. However, the safety and efficacy of LVIS-assisted coiling of acutely ruptured wide-necked intracranial aneurysms have not been well reported. OBJECTIVE To evaluate the safety and efficacy of LVIS-assisted coiling of acutely ruptured wide-necked intracranial aneurysms compared with contemporary coiling-only strategy via propensity score matching in a high-volume center. METHODS A retrospective review of patients with acutely ruptured intracranial aneurysms who underwent LVIS stent placement or coiling only from November 2013 to October 2017 was performed. Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared. RESULTS All baseline characteristics were equivalent between the 2 groups except for neck size. The immediate angiographic results, procedure-related complications, procedure-related mortality, and clinical outcomes between the 2 groups demonstrated no significant differences (P = .087, P = .207, P = .685, and P = .865, respectively). The angiographic follow-up outcomes of the LVIS-assisted coiling group showed a significantly higher complete occlusion rate and lower recurrence rate compared with the coiling-only group (92.3% vs 59.9%, 4.8% vs 26.1%, P

BACKGROUND AND PURPOSE: The Low-Profile Visualized Intraluminal Support (LVIS) stent is a new device recently introduced for the treatment of wide-neck intracranial aneurysms. This single-center study presents the authors' preliminary experience using the LVIS stent to treat saccular aneurysms with parent arteries smaller than 2.5 mm. MATERIALS AND METHODS: Aneurysms with a LVIS stent used in a small parent vessel (

We sought to review the literature concerning stent-assisted coiling (SAC) in comparison with coiling without stents for treating intracranial aneurysms and to evaluate the safety and effectiveness of SAC by conducting a meta-analysis of published studies.According to the methods and guidelines for meta-analysis, PubMed, Embase, and Cochrane Database were searched. All articles that compared SAC and coiling without stent were reviewed. The data extracted were the rates of immediate occlusion, progressive thrombosis, angiographic occlusion, angiographic recurrence, overall complications, ischemic stroke, and hemorrhagic stroke.Sixteen studies with 4294 aneurysms were analyzed. SAC was performed for 1466 aneurysms; and coiling without stent was performed for 2828 aneurysms. No significant difference in immediate occlusion rate was found between the 2 groups (odds ratio [OR] = 1.01; 95% confidence interval [CI], 0.73-1.39, P = 0.96). However, SAC had an advantage in terms of angiographic occlusion rate during follow-up (OR = 1.62, 95% CI: 1.16-2.26, P 0.01), progressive thrombosis rate (OR = 2.54, 95% CI: 2.00-3.24, P0.01), and reduction in recurrence rate (OR = 0.46; 95% CI, 0.35-0.59, P0.01). No significant differences were shown in overall complication rate (OR = 1.30, 95% CI: 086-1.96, P = 0.21) and hemorrhagic stroke rate (OR = 0.72, 95% CI: 0.43-1.20, P = 0.21). Ischemic strokes were more common in the SAC patients than in the non-stent-assisted patients (OR = 1.66; 95% CI: 1.05-2.63, P = 0.03).Compared with coiling without stent, stent-assisted coiling of intracranial aneurysms achieved satisfactory results, with higher long-term angiographic occlusion rate and lower recurrence rate. However, ischemic stroke remains a problem that cannot be ignored.

BackgroundThe low profile visualized intraluminal support (LVIS) device is being increasingly used for the treatment of intracranial aneurysms. Its application in the basilar artery (BA) has not yet been reported.ObjectiveTo evaluate the safety and early efficacy of the LVIS device for the treatment of BA aneurysms.MethodsA prospectively maintained database was retrospectively reviewed for all patients with BA aneurysms treated by LVIS stents at our institution. Angiographic results were evaluated using the modified Raymond–Roy classification (mRRC).Results23 patients (mean age 52.8 years) with a BA aneurysm that was treated by LVIS stent implantation, with (n=21) or without (n=2) adjunctive coiling, were included in our study. 7 aneurysms were treated in the setting of subarachnoid hemorrhage (SAH). 10 aneurysms were located at the basilar tip, 10 at the basilar trunk, and 3 at the superior cerebellar artery. Procedure related complications developed in three patients (13%), including two perforator infarction and one worsening mass effect. Complications resulted in permanent morbidity (4%) in one case. One fatality was related to severe poor grade SAH. At a mean follow-up of 6.9 months, 13 of the 20 patients were mRRC I closure, 3 were mRRC II closure with an improvement from class IIIa, 3 were observed to be recanalized from class IIIa to IIIb, and 1 with stenting only was still patent similar to the immediate angiography.ConclusionThe LVIS stent represents a feasible and safe option for endovascular embolization of BA aneurysms. Although recanalization may occur after LVIS treatment, the mid term complete occlusion rate was acceptable.

We performed this retrospective study to assess the clinical safety and efficacy of the low-profile visualized intraluminal support junior (LVIS Jr.; MicroVention, Aliso Viejo, CA, USA) stent placement in anterior communicating artery (ACA) aneurysms. ACA aneurysms are some of the most common intracranial aneurysms. Stent placement is particularly difficult due to the complexity of the vascular anatomy and the small vessels of the ACA complex. From November 2013 and June 2014, LVIS Jr. stent-assisted coiling was performed in 11 patients with 12 wide-neck ACA aneurysms. Patient demographics, morphologic features of the aneurysm, clinical results and follow-up results are presented. Successful deployment of the LVIS Jr. stent in the targeted artery was achieved in all patients. Complete occlusion was achieved in seven patients, neck remnant in three, and partial occlusion in two. The angiographic follow-up of nine patients (mean 4.4 months) showed that all aneurysms remained stable or improved. There was no in-stent stenosis, recurrence or retreatment. The modified Rankin scale score at discharge was 0 in eight patients and 1 in three patients. The LVIS Jr. stent provided excellent trackability and deliverability and is safe and effective for the treatment of wide-necked ACA aneurysms. Further follow-up is needed to assess the long-term efficacy of LVIS Jr. stent placement in ACA.

Intraprocedural rupture (IPR) is a rare complication that can occur during endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs). However, it universally leads to poor outcomes if not properly managed. In the present study, we sought to illuminate the risk factors for IPR during EVT of UIAs.The data from patients with UIAs who had undergone EVT in our center from January 2010 to March 2017 were retrospectively collected and reviewed. Univariate analysis and multivariate logistic analysis were performed to analyze the risk factors for IPR.A total of 1232 patients with 1312 unruptured aneurysms were included in the present study. IPR occurred in 11 patients (0.9%). Univariate analysis showed that cardiac comorbidities, irregular morphology, and location at the anterior communicating artery (AcomA) were significantly associated with the development of IPR (P0.05). In addition, stent placement was related to a lower risk of IPR compared with no stent placement (P = 0.024). The multivariate analysis showed that cardiac comorbidities (odds ratio [OR], 6.320; P = 0.016), irregular morphology (OR, 9.562; P = 0.001), and location on the AcomA (OR, 6.971; P = 0.006) were independent risk factors for IPR.The occurrence rate of IPR was relatively low. Cardiac comorbidities, irregular morphology, and location on the AcomA are independent risk factors for IPR. Stents and flow diverters are safe and feasible in treating UIA, with a significantly low risk of IPR.

Background Stent-assisted coiling technique has been more and more adopted in the treatment of intracranial aneurysms and has been shown to improve long-term angiographic results; however, the treatment is relatively contraindicated in acutely ruptured aneurysms for its ischemic and hemorrhagic complications. Staged stenting after conventional coiling has emerged as a potential treatment strategy for ruptured wide-neck aneurysms. This study assessed the safety and efficacy of coiling in the acute phase followed by delayed stenting for ruptured wide-neck intracranial aneurysms. Methods Patients with ruptured wide-neck intracranial saccular aneurysms treated with endovascular coiling in acute phase followed by stent placement at a later date (4 weeks) in our center between November 2006 and September 2016 were reviewed. The primary outcomes were procedural safety, target aneurysm rebleeding, and long-term follow-up of clinical and angiographic outcomes. Results A total of 47 patients were enrolled in this study, all patients received staged therapy of stent placement at the required time. The median interval time to retreatment was 4.2 weeks. No cases of rebleeding occurred during the intervals between coiling and stent implantation. No permanent morbidity or mortality resulting from stenting or coiling was observed. All 47 patients underwent angiographic follow-up at a mean of 16.1 months, and complete occlusion was achieved in 38 (80.85%) patients. A total of 44 patients had modified Rankin Scale scores ≤2 during a mean of 21 months. Conclusions Staged treatment of ruptured wide-neck aneurysms with coiling in the acute phase followed by delayed stenting is safe and effective.

Objective Small anterior communicating artery aneurysms with recurrent bleeding and adjacent hematoma may have a high risk of post-operative rebleeding. This clinical study summarizes our preliminary experience with this subset of aneurysms, which were treated with endovascular coiling and subsequent Onyx 34 embolization. Methods We retrospectively reviewed the data of 9 patients suffering from small anterior communicating artery aneurysms treated with the combination of coils and Onyx. The clinical characteristics, angiographic outcomes, and follow-up results are reviewed. Results Endovascular coiling and Onyx embolization were successfully accomplished in all 9 cases. The Raymond scale ratings of the treatments are all class I with the parent arteries kept patent. One patient died of severe brain edema on the 5th post-operative day. The modified Rankin scale (mRS) score for the other 8 patients at follow-ups (6 m to 26 m, 15.8 m on average) was 0 in 5 cases, 1 in 2 cases, and 3 in 1 case. Seven of 8 patients (87.5%) underwent angiographic follow-up that demonstrated persistent durable occlusion with no recanalization. Conclusions Endovascular coiling and subsequent Onyx 34 embolization may be effective in treating anterior communicating artery aneurysms with adjacent hematoma. Further studies with larger sample size and adequate follow-up are required to verify its safety and efficacy as well as to evaluate the long-term outcome.

BackgroundThe low profile visualized intraluminal support (LVIS) device is a new generation of self-expanding braided stents recently introduced into China for stent assisted coiling of intracranial aneurysms. This study assessed the clinical safety and efficacy of the LVIS stent for embolization of intracranial saccular aneurysms.MethodsPatients with intracranial saccular aneurysms treated using the LVIS device in our center between April 2014 and December 2014 were reviewed. The primary outcomes were procedural safety, target aneurysm recurrence, and mid-term follow-up of clinical and angiographic outcomes.Results97 patients with intracranial saccular aneurysms were treated using the LVIS stent, with 100% technical success rate. No mortality was observed. One patient had transient deficit (1/97, 1.0%). Immediate angiographic outcome evaluation showed complete occlusion in 28 (28.8%) and neck remnant in 39 (40.2%) of the 97 patients, respectively. Of the 76 (78.35%) patients who underwent angiographic follow-up at a mean of 8.1 months, complete occlusion was achieved in 64 (84.2%) patients. In the remaining patients, neck remnant in nine (11.8%) and residual sac in three (4%) patients were observed. None of the patients had any target aneurysm recurrence, and the mortality rate was 0%.ConclusionsThe LVIS stent is safe and effective in the treatment of intracranial saccular aneurysms.

Background The management of small, unruptured intracranial aneurysms is still controversial. Given the distinctive natural history of aneurysm at different locations, location-specific analysis might be a reasonable approach. This study aimed to investigate morphological discriminators for rupture status by focusing on only posterior communicating artery (PcomA) aneurysms smaller than 7 mm. Methods In 108 small PcomA aneurysms (68 ruptured, 40 unruptured), clinical and morphological characteristics were compared between the ruptured and unruptured groups. Multivariate logistic regression analysis was performed to determine the independent predictors for the rupture status of small PcomA aneurysms. Results None of the clinical characteristics were significantly different between the ruptured and unruptured groups ( P > 0.05). The ruptured group revealed a significantly larger size ( P = 0.009), aspect ratio ( P = 0.009), size ratio ( P = 0.002), dome-to-neck ratio ( P = 0.002), inflow angle ( P P = 0.039). Bottleneck factor ( P = 0.154), diameter of PcomA ( P = 0.302), and fetal-type PcomA ( P = 0.832) showed no significance. With multivariate analyses, size ratio ( P = 0.012) and inflow angle ( P = 0.001) were shown to be independently associated with the rupture status of small PcomA aneurysms. Conclusions Morphological characteristics were closely related with the rupture status of small PcomA aneurysms. Size ratio and inflow angle were independent risk factors for rupture and might be useful in clinical risk stratification of small PcomA aneurysms.

Background Middle cerebral artery (MCA) aneurysms often occur in small parent vessels and are incorporated with the orifice of acute-angled efferent branch vessels. Endovascular treatment for these aneurysms remains technically challenging. This study aimed to assess the clinical safety and efficacy of the Low-profile Visualized Intraluminal Support Junior (LVIS Jr) stent for embolization of MCA aneurysms. Methods Eighteen intracranial aneurysms, including 13 unruptured and 5 ruptured aneurysms, were treated with LVIS Jr stent–assisted coil embolization. The clinical data and technical results are presented. Results A total of 18 stents were successfully delivered to the target aneurysms, and the technical success rate was 100%. There was complete occlusion in 8 (44.4%) of 18 cases, neck remnants in 7 (38.9%) cases, and partial occlusion in 3 (16.7%) cases. In-stent thrombosis occurred in 1 case, and the symptoms disappeared after transvenous tirofiban injection. The modified Rankin Scale score at discharge was 0 in 14 patients, 1 in 3 patients, and 2 in 1 patient. Conclusions The LVIS Jr stent provided excellent trackability and deliverability and is safe and effective for the treatment of wide-necked MCA aneurysms with tortuous and smaller parent vessels.

Background Wingspan stenting for the treatment of complex intracranial atherosclerotic stenosis (ICAS), i.e., that involving tortuous vascular pathways, long (>15 mm) lesions or arterial bifurcations, has a relatively high risk of complications. This retrospective study assessed the safety and efficacy of undersized balloon angioplasty followed by deployment of the more flexible Enterprise stent for the treatment of complex symptomatic ICAS. Methods Forty-four patients on combined antiplatelet therapy and intensive risk factor management and a symptomatic 70–99 % stenosis of a major intracranial artery in complex settings that was treated with balloon angioplasty and Enterprise stent deployment between July 2009 and August 2013 were enrolled. Primary outcome was occurrence of ischemic or hemorrhagic stroke or death within 30 days after intervention. Secondary outcomes included procedural success (defined as achievement of 50 % in-stent restenosis after mean 22 months follow-up. Conclusion In this retrospective, single-center experience, undersized balloon angioplasty followed by Enterprise stent deployment appears technically feasible with a relatively low rate of complications for the treatment of complex symptomatic ICAS. Prospective, multicenter, randomized controlled trials against optimal medical management are warranted.