Background

Different endovascular techniques exist for treatment of cerebral wide-necked bifurcation aneurysms (WNBA). We present the “shelf” technique with the novel woven LVIS EVO stent, which enables forming a buttress at the level of the aneurysm neck to prevent coil prolapse and additional stenting.

Methods

Single-center retrospective analysis of patients treated with the “shelf” technique by using LVIS EVO stent in incidental WNBAs between January 2020 and March 2021. Inclusion criteria were saccular aneurysms with neck width ≥4 mm or a dome/neck ratio ≤2. Primary endpoint was a favorable navigation to the target vessel and successful deployment of the LVIS EVO stent with forming a buttress that enables aneurysm occlusion by subsequent coiling. Secondary endpoints were aneurysm occlusion on follow-up, procedure-related complications and clinical outcome.

Results

A total of 15 patients were included. The primary end point was reached in 100% of cases. A complete aneurysm occlusion at the end of the procedure was achieved in 14/15 patients (93%). No intraprocedural complications occurred. All patients except one were discharged with an modified Rankin Scale (mRS) of 0. Procedure-related morbidity was 7%. Median follow-up imaging was 115 days (7–419 days) and available for 11/15 (73%) of the patients. Of those, 10 (91%) individuals had a complete aneurysm occlusion and 1 showed a residual neck. In all patients, the covered branch was patent and no ischemic complications occurred during follow-up.

Conclusion

This study demonstrates the “shelf” technique with LVIS EVO stents as a feasible and safe treatment option for WNBAs with very good short-term occlusion rates.

中文翻译：

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使用新型编织自扩张支架治疗宽颈分叉动脉瘤的“货架”技术

背景

存在用于治疗脑宽颈分叉动脉瘤 (WNBA) 的不同血管内技术。我们展示了新型编织 LVIS EVO 支架的“搁板”技术，该技术能够在动脉瘤颈部水平形成支撑，以防止线圈脱垂和额外的支架。

方法

对 2020 年 1 月至 2021 年 3 月期间在偶然 WNBA 中使用 LVIS EVO 支架接受“搁板”技术治疗的患者进行单中心回顾性分析。纳入标准为颈宽≥4 mm 或圆顶/颈比≤2 的囊状动脉瘤。主要终点是对目标血管的有利导航和 LVIS EVO 支架的成功部署，形成了一个支撑物，通过随后的卷取使动脉瘤闭塞成为可能。次要终点是动脉瘤闭塞的随访、手术相关并发症和临床结果。

结果

共纳入 15 名患者。100% 的病例达到了主要终点。14/15 名患者 (93%) 在手术结束时实现了完全动脉瘤闭塞。未发生术中并发症。除一名患者外，所有患者均以改良 Rankin 量表 (mRS) 为 0 出院。手术相关发病率为 7%。中位随访成像时间为 115 天（7-419 天），可供 11/15（73%）的患者使用。其中，10 人 (91%) 人完全动脉瘤闭塞，1 人显示残留颈部。在所有患者中，覆盖分支是通畅的，并且在随访期间没有发生缺血性并发症。

结论

这项研究证明了 LVIS EVO 支架的“搁置”技术是一种可行且安全的 WNBA 治疗选择，具有非常好的短期闭塞率。