J Korean Neurosurg Soc.  2022 Jul;65(4):523-530. 10.3340/jkns.2021.0275.

Overlapping Stents-Assisted Coiling for Vertebral Artery Dissecting Aneurysm : LVIS Stent within Neuroform EZ Stent

• Liu XL
• Wang B
• Zhao LB
• Jia ZY
• Shi HB
• Liu S

• KMID: 2531621
• DOI: http://doi.org/10.3340/jkns.2021.0275

Abstract

Objective
: To evaluate the safety and efficacy of an overlapped stenting-assisted coiling technique in treating vertebral artery dissecting aneurysm (VADA) via Low-profile Visualized Intraluminal Support (LVIS) stent-within-Neuroform EZ stent.
Methods
: From January 2017 to June 2019, 18 consecutive patients with VADAs (ruptured : unruptured=5 : 13) were treated with the overlapping stents assisted-coiling technique in our center. The overlapping manner was a Neuroform EZ stent being deployed first, followed by LVIS stents placement using the ‘shelf’ technique. The patients’ clinical characteristics, technical feasibility and safety, and immediate and follow-up angiographic results were retrospectively reviewed.
Results
: Seventeen (94.4%) procedures were technically successful with an exact deployment of the stents and patent parent or perforator arteries. The immediate angiographies after procedure confirmed Raymond class I, II, and III occlusion of VADAs were in 12 (66.7%), two (11.1%), and four cases (22.2%), respectively. Post-procedural complications developed in one patient (5.6%) with minor brainstem infarctions, which resulted from an in-stent thrombosis during the procedure. Angiographic follow-up at 5.7 months (range 3 to 9 months) demonstrated Raymond class I and II occlusion were in all cases (100%). The modified Rankin Scale scores at 21.3 months (range 15 to 42 months) 0–2 in 17 cases (94.4%) and three in one case (5.6%).
Conclusion
: Overlapping stents via LVIS stent-within-Neuroform EZ stent combined with coiling is safe and effective for patients with VADA in the midterm results.

Keyword

Intracranial aneurysm; Dissecting vertebral artery aneurysm; Endovascular procedures; Stents

Figure

• 

  Fig. 1. It shows the treatment procedure and follow-up angiography of a 41-year-old female (case 9) with a ruptured vertebral artery dissecting aneurysm (VADA). A : Angiography before procedure shows the VADA (white arrow). B and C : Angiography after the first stent deployment. C : White arrowheads show that the coils at the neck of the VADA were relatively loose before the second stent insertion. D and E : Angiography after the second stent deployment. E : White arrowheads show that the coils become more compacted. F : Follow-up angiography at 3 months shows the complete occlusion of the aneurysm.

• 

  Fig. 2. It shows that one patient (case 6) with an initial Raymond class III improved to class I during a 3-month angiographic follow-up. A : The initial angiography showed the vertebral artery dissecting aneurysm. B : Angiography after the procedure showed the aneurysm sac filling (arrowheads). C : Angiography after 3 months elucidated that no contrast filled the aneurysm (arrows).

Reference

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