Journal of Clinical Neuroscience 22 (2015) 1288–1291
Contents lists available at ScienceDirect
Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn
Clinical Study
Endovascular treatment of wide-neck anterior communicating artery aneurysms using the LVIS Junior stent Zhengzhe Feng a,1, Lei Zhang b,1, Qiang Li a, Rui Zhao a, Yi Xu a, Bo Hong a, Wenyuan Zhao a, Jianmin Liu a, Qinghai Huang a,⇑ a b
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China Department of Neurology, Shandong Ji’ning First People’s Hospital, Ji’ning, China
a r t i c l e
i n f o
Article history: Received 26 October 2014 Accepted 4 February 2015
Keywords: Aneurysm Anterior communicating artery Stent Wide-neck
a b s t r a c t 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. Ó 2015 Elsevier Ltd. All rights reserved.
1. Introduction
2. Materials and methods
The anterior communicating artery (ACA) is one of the most common locations for intracranial aneurysms. Currently, endovascular treatment is widely accepted as an alternative to surgical clipping when treating ACA aneurysms [1]. Although several articles have reported successful embolization of ACA aneurysms with minimal complications, endovascular treatment for wide-neck ACA aneurysms remains technically challenging [2–4]. In addition, the safety of stenting in small vessels needs further investigation. The low-profile visualized intraluminal support junior stent (LVIS Jr.; MicroVention, Aliso Viejo, CA, USA), which is compatible with 0.017 inch microcatheters, is expected to address this issue. The purpose of this clinical study was to evaluate the safety and efficacy of the LVIS Jr. intracranial microstent in assisting coil embolization of wide-neck ACA aneurysms.
2.1. Patient population
⇑ Corresponding author. Tel.: +86 21 31161794. 1
E-mail address: [email protected] (Q. Huang). These authors have contributed equally to the manuscript.
http://dx.doi.org/10.1016/j.jocn.2015.02.020 0967-5868/Ó 2015 Elsevier Ltd. All rights reserved.
Between November 2013 and June 2014, 12 ACA aneurysms in 11 patients were treated with the LVIS Jr. stent at our institution including nine men and two women with a mean age of 52.7 years (range: 46–69). Of the 12 aneurysms, seven were ruptured and five were unruptured. Using the Hunt and Hess grading system, the subarachnoid hemorrhages of five patients were classified as Grade I, one patient as Grade II and one as Grade III.
2.2. Aneurysm and vascular morphology There were four patients with multiple aneurysms. Both conventional and rotational intra-arterial DSA were performed for 3D reconstruction in all patients. Wide-neck aneurysm was defined as a fundus-to-neck ratio 4 mm. The aneurysm neck was located at the A1–A2 junction in seven patients and based directly on the ACA in the other four patients.
Z. Feng et al. / Journal of Clinical Neuroscience 22 (2015) 1288–1291
The maximal diameter of the aneurysm sac ranged from 1.9 to 9.2 mm with a mean of 4.8 mm. Twelve aneurysms were divided into three tiny aneurysms (
Contents lists available at ScienceDirect
Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn
Clinical Study
Endovascular treatment of wide-neck anterior communicating artery aneurysms using the LVIS Junior stent Zhengzhe Feng a,1, Lei Zhang b,1, Qiang Li a, Rui Zhao a, Yi Xu a, Bo Hong a, Wenyuan Zhao a, Jianmin Liu a, Qinghai Huang a,⇑ a b
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China Department of Neurology, Shandong Ji’ning First People’s Hospital, Ji’ning, China
a r t i c l e
i n f o
Article history: Received 26 October 2014 Accepted 4 February 2015
Keywords: Aneurysm Anterior communicating artery Stent Wide-neck
a b s t r a c t 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. Ó 2015 Elsevier Ltd. All rights reserved.
1. Introduction
2. Materials and methods
The anterior communicating artery (ACA) is one of the most common locations for intracranial aneurysms. Currently, endovascular treatment is widely accepted as an alternative to surgical clipping when treating ACA aneurysms [1]. Although several articles have reported successful embolization of ACA aneurysms with minimal complications, endovascular treatment for wide-neck ACA aneurysms remains technically challenging [2–4]. In addition, the safety of stenting in small vessels needs further investigation. The low-profile visualized intraluminal support junior stent (LVIS Jr.; MicroVention, Aliso Viejo, CA, USA), which is compatible with 0.017 inch microcatheters, is expected to address this issue. The purpose of this clinical study was to evaluate the safety and efficacy of the LVIS Jr. intracranial microstent in assisting coil embolization of wide-neck ACA aneurysms.
2.1. Patient population
⇑ Corresponding author. Tel.: +86 21 31161794. 1
E-mail address: [email protected] (Q. Huang). These authors have contributed equally to the manuscript.
http://dx.doi.org/10.1016/j.jocn.2015.02.020 0967-5868/Ó 2015 Elsevier Ltd. All rights reserved.
Between November 2013 and June 2014, 12 ACA aneurysms in 11 patients were treated with the LVIS Jr. stent at our institution including nine men and two women with a mean age of 52.7 years (range: 46–69). Of the 12 aneurysms, seven were ruptured and five were unruptured. Using the Hunt and Hess grading system, the subarachnoid hemorrhages of five patients were classified as Grade I, one patient as Grade II and one as Grade III.
2.2. Aneurysm and vascular morphology There were four patients with multiple aneurysms. Both conventional and rotational intra-arterial DSA were performed for 3D reconstruction in all patients. Wide-neck aneurysm was defined as a fundus-to-neck ratio 4 mm. The aneurysm neck was located at the A1–A2 junction in seven patients and based directly on the ACA in the other four patients.
Z. Feng et al. / Journal of Clinical Neuroscience 22 (2015) 1288–1291
The maximal diameter of the aneurysm sac ranged from 1.9 to 9.2 mm with a mean of 4.8 mm. Twelve aneurysms were divided into three tiny aneurysms (
