Lim Yong Cheol, Shin Yong Sam, Chung Joonho
Department of Neurosurgery, Ajou University College of Medicine and Hospital, Suwon, Republic of Korea.
Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University, Seoul, Republic of Korea.
World Neurosurg. 2018 Sep;117:203-207. doi: 10.1016/j.wneu.2018.06.029. Epub 2018 Jun 15.
A new Low-profile Visualized Intraluminal Support device (LVIS Blue) is a braided stent that provides a higher degree of metal coverage. This stent may be beneficial for complete obliteration of an aneurysm due to not only its support of a higher occlusion rate using coils inside of the aneurysm but also its flow-diverting effect. We introduce and describe a new flow-diversion technique using an LVIS Blue stent within an Enterprise stent for patients with vertebral artery (VA) dissecting aneurysms. A 6-Fr guiding catheter was positioned in the ipsilateral VA. A microcatheter with an inner diameter of 0.021 inches was navigated and positioned across the dissecting segment of the VA. An Enterprise stent was then deployed and used to cover the dissecting segment by pushing the pusher wire of the stent while simultaneously unsheathing the microcatheter. The microcatheter was navigated along the remaining pusher wire to the distal VA through the Enterprise stent. An LVIS Blue stent was introduced and positioned such that it overlapped the previous stent in order to divert blood flow away from the dissecting segment. We present a case in which this technique was used to successfully obliterate a dissecting aneurysm while maintaining the VA patency with vessel wall remodeling. The LVIS Blue stent-within-an-Enterprise stent technique may be an effective treatment option for patients with VA dissecting aneurysms as an alternative technique to flow diverters.
一种新型的低轮廓可视化腔内支撑装置（LVIS Blue）是一种编织支架，具有更高的金属覆盖率。由于该支架不仅能通过在动脉瘤内使用弹簧圈来提高闭塞率，还具有血流导向作用，因此可能有助于完全闭塞动脉瘤。我们介绍并描述了一种在Enterprise支架内使用LVIS Blue支架的新血流导向技术，用于治疗椎动脉（VA）夹层动脉瘤患者。将一根6F引导导管置于同侧椎动脉内。将一根内径为0.021英寸的微导管导航并定位在椎动脉的夹层段。然后展开Enterprise支架，通过推动支架的推送钢丝同时抽出微导管，使其覆盖夹层段。微导管沿着剩余的推送钢丝穿过Enterprise支架进入椎动脉远端。引入并定位LVIS Blue支架，使其与先前的支架重叠，以将血流从夹层段引开。我们展示了一个病例，该技术成功闭塞了夹层动脉瘤，同时通过血管壁重塑维持了椎动脉通畅。对于VA夹层动脉瘤患者，LVIS Blue支架在Enterprise支架内的技术可能是一种有效的治疗选择，可作为血流导向器的替代技术。
