As flow diversion becomes increasingly more popular, this article addresses a highly relevant topic and therefore represents a valuable addition to the literature. A clinical study has indicated that mca aneurysms are typically complex, multilobed and incorporate eloquent vascular branches. Endovascular treatment of middle cerebral artery aneurysm. The progress in endovascular management of intracranial. Accumulation of laser dye yellow within the aneurysm, indicating that stasis is visualized after stent. Treatment of intracranial aneurysms with selfexpandable. We sought to evaluate the lvis blue as a standalone flow diverter for the treatment of intracranial aneurysms. Stent anchor technique to reduce microcatheter loop for. Issuu is a digital publishing platform that makes it simple to publish magazines, catalogs, newspapers, books, and more online. Lowprofile visualized intraluminal support junior device.
Introduction the lvis stent system lvis and lvis junior is a selfexpanding, retrievable, microstent system indicated for the treatment of widenecked cerebral aneurysms wnas. The mca bifurcation is a preferred site for aneurysm formation, and is involved in 1820% in all aneurysms encountered. A 32yearoldwoman presented with traumatic facial injuries from a horseback riding incident. A new lowprofile visualized intraluminal support device lvis blue is a braided stent that pro vides a higher degree of metal coverage and. Laserinduced fluorescence study visualizing complex flow patterns in an in vitro aneurysm model during peak systole a and c and during diastole b and d before a and b and after c and d stent arrows placement across the aneurysm neck large arrows indicate direction of flow. Access with both stent delivery systems were easy, and the aneurysm neck was covered sufficiently. Dec 17, 2019 the authors 1 provide a wellwritten overview of the currently available platelet function tests and antiplatelet regimens for flow diversion of cerebral aneurysms. Stentassisted coil embolization sace is a popular treatment strategy for widenecked intracranial aneurysms ias and is associated with a higher occlusion rate and lower recurrence rate 15.
Flow diverter effect of lvis stent on cerebral aneurysm hemodynamics. Cureus yshaped lvis stentassisted coiling of anterior. The aim of this study was to quantify the effect of the new lowprofile visualized intraluminal support lvisd device and the difference of fluid diverting effect compared with the pipeline device and the enterprise stent using computational fluid dynamics cfd. Pdf flow diverter effect of lvis stent on cerebral aneurysm. Ge et al have indicated that endovascular treatment with lvis stent may achieve a greater complete or nearcomplete occlusion rate compared with the non lvis stent treatment. Lvis stent versus enterprise stent for the treatment of. Microventionterumo device have been successfully and safely used to treat widenecked and complex aneurysms. We conducted a computational fluid dynamics cfd study and compared the treatment of mediumsized intracranial aneurysms. Introduction the lvis stent system lvis and lvis junior is a selfexpanding, retrievable, microstent system. Nevertheless, the doublelvis stent resulted in a better flow diverting effect than a pipeline device. Lvis stent versus enterprise stent for the treatment of unruptured intracranial aneurysms. This singlecenter study presents the authors preliminary experience using the lvis stent to treat saccular aneurysms with parent arteries smaller than 2. Author links open overlay panel huijian ge 1 2 xianli lv 1 2 xinjian yang 1 2 hongwei he 1 2 hengwei jin 1 2 youxiang li 1 2. Staged endovascular reconstruction of complex traumatic.
It decreased the risk of a second operation and procedurerelated complications compared with surgical clipping. The fda has given microvention, a division of terumo, approval for the companys lowprofile visualized intraluminal support device lvis and lvis jr. Overlapping of an lvis blue stent to the enterprise stent, the metal coverage surface area about 33% may be enough to act like flow diverters in a straight vessel see figure 3. Some studies indicate potential flow diverter properties. It was reported that after the stents were removed and it was decided to terminate the procedure, it was noticed that there was a carotid dissection in the ica at the location of the guide catheter tip. Keywords intracranial aneurysm, lvis stent, small parent vessel diameter. The lowprofile visualized intraluminal support lvis junior stent is dedicated for endovascular treatment of wideneck intracranial aneurysms located on smalldiameter vessels 23. Welcome to the indiana department of educations licensing verification and information system fondly known at the doe as lvis. We report our singlecenter experience utilizing lvis jr. Delivery through scepter balloons 1 balloon assisted embolization 2 after balloon deflation, if a coil prolapses into the parent vessel 3 deliver lvis jr. The leo baby stent has a cell size of approximately 0.
The safety and effectiveness of the lvis stent system for the treatment of widenecked cerebral aneurysms. Tso md, phd 1, 3, muhammad waqas mbbs 1, 3 and elad i. The safety and effectiveness of the lvis stent system for. Stentassisted coil embolization sace was performed by inserting an lvis jr.
It was reported that after the stents were removed and it was decided to terminate the procedure, it was noticed that there was a carotid dissection in the. We conducted a computational fluid dynamics cfd study and compared the treatment of mediumsized intracranial aneurysms with lvis and enterprise stent assisted coil embolization sace to determine the effects of hemodynamic changes caused by different stent and coil packing densities pds in endovascular treatment. Stent anchor technique to reduce microcatheter loop for stentassisted coiling of anterior communicating artery aneurysm kunal vakharia md 1, 3, stephan a. Lvis blue is a stent with 28% metal coverage approved for use as a coil adjuvant. Introduction the lvis stent system lvis and lvis junior is a self expanding, retrievable, microstent system. Preliminary experience with stentassisted coiling of. The lowprofile visualized intraluminal support lvis stent is a new device recently introduced for the treatment of wideneck intracranial aneurysms.
Methods the us lvis pivotal trial was a prospective, multicenter, singlearm, interventional study conducted at 21 us. Stentassisted coil embolization of unruptured vertebral. The clinical presentation, aneurysmal characteristics, technical feasibility, procedural complications, as well as. Cerebral aneurysms treated with lowprofile visualized. Flow diversion via lvis blue stent within enterprise stent in. Overview of newer stent devices for aneurysm treatment. The clinical presentation, aneurysmal characteristics, technical feasibility, procedural complications, as well as angiographic and clinical follow. With this braided technology the stent cells are moveable, allowing microcatheters from 0. Complications were reported in 8 cases in lvis group and 16 cases in clipping group, with significant difference p lvis stent assisted coiling has better prognosis than surgical clipping. Ct angiogram of the head showed complex craniofacial injuries, including a transverse fracture transecting the clivus and the left petrous temporal bone, with sah in. Early case series suggest that the recently introduced lowprofile visualized intraluminal support junior lvis jr. The safety and effectiveness of the lvis stent system for the.
Background the low profile visualized intraluminal support lvis device is a new generation of selfexpanding braided stents recently introduced into china for stent assisted coiling of intracranial aneurysms. She was found to have a glasgow coma score of 3t, left eyelid ptosis with a fixeddilated pupil and a flaccid right upper extremity. A single lvis stent caused more wall shear stress reduction than double enterprise stents 39. The present pivotal study was performed to evaluate the safety and effectiveness of this device. The purpose of this study is to evaluate the safety and probable benefit of the lowprofile visualized intraluminal support lvis and lvis jr. Efficient simulation of a lowprofile visualized intraluminal. This new online application system has been designed with enhanced selfservice features to make it easier and faster for you to apply for and receive your credentials. Feasibility study of the lvis lowprofile visualized.
Utility of lowprofile visualized intraluminal support junior stent as. The authors 1 provide a wellwritten overview of the currently available platelet function tests and antiplatelet regimens for flow diversion of cerebral aneurysms. In addition, braided stents, like lvis jr, may have a number of advantages over their laser cut competition including perhaps increased metal coverage, improved neointimal growth, the ability to shelf the stents and more reliable opening. The aim of our study is to evaluate the feasibility, safety, and efficacy of the lvis device in reconstructive treatment of vertebral artery dissecting aneurysms vadas. A new lowprofile visualized intraluminal support device lvis blue is a braided stent that provides a higher degree of metal coverage. This study was approved by authors ethical committees. Bending expectations of conformability and stability the neuroform atlas stent system is purposefully designed to provide the coil support and wall apposition needed to perform effective stent assisted coiling procedures.
However, stent assisted coil embolization with a standard stent deploying technique for an intracranial saccular aneurysm may cause branch and perforator occlusion when gaps are present between the stent and orifice of these branches. Lowprofile visualized intraluminal support junior device for. To achieve better treatment of aneurysms using lvis, we developed a fast virtual stenting technique for use with lvis f lvis to evaluate hemodynamic changes in the aneurysm and validate its reliability. This study assessed the clinical safety and efficacy of the lvis stent for embolization of intracranial saccular aneurysms. Stryker neurovascular neuroform atlas stent system. However, widenecked, complex or dissecting aneurysms that incorporate a large portion of the parent artery can still be a challenge to treat and usually require scaffolding or bridging of the neck by special stents, combined with aneurysm coiling or flow diverters 1, 2. Reconstructive endovascular treatment of vertebral artery. In this research, we simulated three aneurysms constructed from 3d digital subtraction angiography dsa. Softwarebased simulation for preprocedural assessment of. Endovascular intervention with a lowprofile visualized. However, every effort should be made to jail the microcatheter before stent. We report a multicenter experience using the lvis jr stent for ystentassisted coiling embol.
Lvis jr device for ystentassisted coil embolization of wideneck. The progress in endovascular management of intracranial aneurysms. This study reports midterm clinical and anatomical results of this device. Mar 22, 2018 the lowprofile visualized intraluminal support lvis stent has become a promising endovascular option for treating intracranial aneurysms. Introduction the lowprofile visualized intraluminal support lvis device is a new generation of selfexpanding braided stent recently introduced in china for stent assisted coiling of intracranial aneurysms. A total of 92 patients who underwent endovascular treatment of mca aneurysms with lvis stent or non. We found that the lvis stent has certain hemodynamic effects on cerebral aneurysms. Flow diversion via lvis blue stent within enterprise stent. Lvis stent versus enterprise stent for the treatment of unruptured intracranial. We conducted a computational fluid dynamics cfd study and compared the treatment of mediumsized intracranial aneurysms with lvis. Flow diverter effect of lvis stent on cerebral aneurysm. The strategies used and evaluated for stent deployment in relation to coiling in 53 treated aneurysms were as follows.
Authorized by federal law for use with bare platinum embolic coils for the treatment of unruptured, wide neck neck. However, stentassisted coil embolization with a standard stent deploying technique for an intracranial saccular aneurysm may cause branch and perforator occlusion when gaps are present between the stent and orifice of these branches. This retrospective study enrolled 39 patients with bbas who underwent. On b6 2012, we received a complaint that an lvis stent 2 did not appear to expand during deployment. By reducing the transition zone of the unconstrained segment of the lvis blue stent, the enterprise stent enhances the flowdiverting effect of the lvis blue stent. We enrolled 87 consecutive patients, with 87 medium. 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. To achieve better treatment of aneurysms using lvis, we developed a fast virtual stenting technique for use with lvis flvis to evaluate hemodynamic changes in the aneurysm and validate its reliability. The lowprofile visualized intraluminal support lvis stent has become a promising endovascular option for treating intracranial aneurysms. Stent in combination with a 316l stainless steel alloy stent guidant multilink tetra coronary stent. Stentassisted coiling of intracranial aneurysms located. This study compared the clinical outcomes and complications between endovascular intervention with lowprofile visualized intraluminal support lvis stentassisted coiling and the surgical clipping in patients with bbas. May 31, 2018 microvention announces fda approval for neuro stent device the lvis and lvis jr.
1444 114 882 378 1126 633 250 1447 584 256 1558 339 97 528 1590 1120 353 48 895 1405 1401 657 999 167 830 1005 20 438 445 152 190 607 938 405 911 312 4 1159 678 985 14