Neuroendovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Neuroendovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; Neurosurgical Department, Mazandaran University of Medical Sciences, Sari, Iran.
World Neurosurg. 2024 Jul;187:e534-e542. doi: 10.1016/j.wneu.2024.04.122. Epub 2024 Apr 25.
The Low-Profile Visualized Intraluminal Support (LVIS) device has been frequently used as an intracranial stent for treating intracranial aneurysms. However, the feasibility and efficacy of LVIS devices in Y-stent-assisted coiling (Y-SAC) have remained contentious. This study aimed to evaluate long-term angiographic and clinical outcomes of Y-SAC using LVIS devices.
We retrospectively reviewed the clinical presentation and angiography data of patients treated with Y-SAC using LVIS stents. The vascular angle geometry between the parent and the 2 branch vessels, before and after stent deployment and after coiling, were analyzed. Based on the Raymond-Roy Occlusion Classification (RROC), aneurysm occlusion status was classified. Clinical outcomes were assessed using the modified Rankin Scale.
Forty patients with 40 aneurysms were included in this study. Immediate postprocedural angiograms showed complete/near-complete occlusion (RROC 1 and 2) in 31 aneurysms (77.5%). The long-term follow-up angiographic studies were available in 32 patients and showed RROC class 1 and 2 in 93.8% of patients. Y-SAC with LVIS devices significantly decreased the angle between the bifurcation branches from 171.90° ± 48.0° (standard deviation) to 130.21° ± 46.3° (standard deviation) (P < 0.0001). Periprocedural complications occurred in 5 patients (12.5%) including 4 in-stent thromboses (10.5%). Thirty-six patients (90.0%) had favorable clinical outcomes at the final follow-up. Univariate analysis showed that World Federation of Neurological Societies grade 3-5, thickness of subarachnoid hemorrhage on head computed tomography, intraprocedural complications, and in-stent thrombosis were predictors of poor outcome.
Y-SAC using the LVIS device for intracranial bifurcation aneurysms is a feasible and relatively safe procedure with favorable long-term angiographic and clinical outcomes.
低轮廓可视化腔内支撑（LVIS）装置已被广泛用作治疗颅内动脉瘤的颅内支架。然而，LVIS 装置在 Y 型支架辅助弹簧圈（Y-SAC）中的应用的可行性和疗效仍存在争议。本研究旨在评估使用 LVIS 装置进行 Y-SAC 的长期血管造影和临床结果。
我们回顾性分析了使用 LVIS 支架进行 Y-SAC 的患者的临床表现和血管造影数据。分析了支架置入前后及弹簧圈置入后母血管与 2 个分支血管之间的血管角度几何形状。根据 Raymond-Roy 闭塞分类（RROC）对动脉瘤闭塞状态进行分类。使用改良 Rankin 量表评估临床结果。
本研究共纳入 40 例 40 个动脉瘤患者。即刻血管造影显示 31 个动脉瘤（77.5%）完全/近完全闭塞（RROC 1 和 2）。32 例患者可进行长期随访血管造影研究，93.8%的患者 RROC 分级为 1 级和 2 级。使用 LVIS 装置进行 Y-SAC 可显著减小分叉分支之间的角度，从 171.90°±48.0°（标准差）减小至 130.21°±46.3°（标准差）（P＜0.0001）。5 例患者（12.5%）发生围手术期并发症，包括 4 例支架内血栓形成（10.5%）。36 例患者（90.0%）在最终随访时临床结果良好。单因素分析显示，世界神经外科联合会（WFNS）分级 3-5 级、头 CT 显示蛛网膜下腔出血厚度、术中并发症和支架内血栓形成是预后不良的预测因素。
对于颅内分叉动脉瘤，使用 LVIS 装置进行 Y-SAC 是一种可行且相对安全的方法，具有良好的长期血管造影和临床结果。
