Long-term outcomes of wide-neck intracranial aneurysms treated with LVIS EVO–assisted coiling: a multicenter retrospective study

Abstract

Stent-assisted coiling (SAC) is a well-defined and widely performed endovascular technique used to treat wide-neck aneurysms. The Low-Profile Visualized Intraluminal Support (LVIS) EVO stent is a newly-developed, low-profile, braided stent with a composite wire structure providing full stent visibility under fluoroscopy. Although the initial and midterm results of patients with intracranial aneurysms treated with LVIS EVO-assisted coiling have been reported, no published long-term aneurysm occlusion or complication data exist for the LVIS EVO stent. This retrospective study aimed to evaluate the long-term safety and durability of the SAC procedure using an LVIS EVO stent for the treatment of wide-neck and complex aneurysms. MATERIALS AND METHODS: A retrospective review of databases of 4 centers was performed to identify the patients with aneurysms treated with LVIS EVO-assisted coiling. Patients with a clinical and angiographic follow-up duration of at least 12 months were included. The technical success of the procedure and the immediate clinical and angiographic outcomes were assessed. Periprocedural and delayed complications were evaluated. Follow-up angiographic and clinical outcomes were investigated. Preprocedural and follow-up neurologic statuses were assessed using the mRS. The aneurysm occlusion status was assessed using the Raymond-Roy (RR) classification. RESULTS: A total of 158 patients (96 women; mean age, 54.4 [SD, 11.9] years) with 158 aneurysms were included. The technical success of the procedure was 99.4%. Immediate postprocedural angiography showed complete occlusion in 71.5% of patients. Every patient underwent at least 2 angiographic follow-ups. The last follow-up angiography evaluation showed a complete aneurysm occlusion (RRI) in 85.4% and an adequate occlusion (RRI-RRII) in 96.8% of patients. Recanalization was observed in 8.2% of the patients. Two patients (1.3%) required retreatment. In addition, 8.9% of patients had complications resulting in a morbidity rate of 4.4% (mRS scores, 1-3). At the last follow-up, 91.8% of the patients had an mRS score of ≤1. CONCLUSIONS: The results of this case series demonstrated the long-term safety and durability of the LVIS EVO-assisted coiling procedure for the treatment of wide-neck and complex aneurysms.