Elsevier

World Neurosurgery

Volume 109, January 2018, Pages e99-e104
World Neurosurgery

Original Article
Comparison of Recanalization and In-Stent Stenosis Between the Low-Profile Visualized Intraluminal Support Stent and Enterprise Stent-Assisted Coiling for 254 Intracranial Aneurysms

https://doi.org/10.1016/j.wneu.2017.09.112Get rights and content

Objective

To compare the rates of recanalization and in-stent stenosis between the Enterprise (EP) and low-profile visualized intraluminal support (LVIS) stent deployments for intracranial aneurysms (IAs), and the factors associated therein.

Methods

Between June 2014 and July 2016, 142 patients with a total of 161 IAs were treated by LVIS stent-assisted coiling and 111 patients with a total of 142 IAs were treated by EP stent-assisted coiling at our institution. Procedure-related complications, angiographic follow-up results, and clinical outcomes were analyzed statistically.

Results

The rates of initially complete and near-complete IA occlusion immediately after the procedure were similar in the LVIS and EP groups (94.3% vs. 89.9%; P = 0.275). On follow-up, complete and near-complete occlusion rates and recanalization rates were also similar in the 2 groups (96.6% vs. 92.1%; P =0.330 and 8.0% vs. 13.5%; P = 0.245, respectively). On logistic regression analysis, a higher size ratio (SR) was significantly associated with the recanalization of aneurysms in the EP group, but not in the LVIS group. The rate of moderate to severe in-stent stenosis was lower in the LVIS group (10.2%) than in the EP group (16.8%), but the difference was not statistically significant (P = 0.198).

Conclusions

Our data show acceptable rates of complete and near-complete occlusion with both the LVIS and EP stents. LVIS stents were associated with lower rates of recanalization and in-stent stenosis, but the difference was not significant. Higher SR (≥2) was a significant predictor of recanalization in IAs treated with EP stents, but not in those treated with LVIS stents.

Introduction

Despite the advances in devices and endovascular techniques, endovascular treatment of intracranial aneurysms (IAs) with wide necks, unfavorable dome-to-neck ratios, or complex morphologies remains a challenge.1 The Enterprise (EP) stent is widely used for stent-assisted coiling of IAs. The EP is characterized by its self-expanding design. It has been proven to service as a scaffold to prevent coil prolapse and enhance coil packing density with greater stability of coil mass.2, 3

Recently, the low-profile visualized intraluminal support (LVIS) stent has emerged as a valuable alternative to the EP. With its smaller cell structure (0.9 mm) and higher metal coverage (12%–23%), this stent has been associated with greater complete or near-complete occlusion rates and superior flow diversion on immediate postoperative angiograms compared with the EP.4, 5 Although the LVIS can be efficiently applied in IAs with complex morphologies or wide necks, the main concern associated with its use is the possibility of delayed hemorrhage and ischemic complications due to recanalization and postprocedure in-stent stenosis.6, 7, 8 Thus, a deeper understanding of the long-term data on angiographic outcomes and in-stent stenosis following LVIS and EP stent deployment is needed to help guide treatment decisions and prognostic assessment.

In the present study, we analyzed and compared longer-term angiographic outcomes and in-stent stenosis rates in 254 consecutive patients with IAs treated with the EP or LVIS stent. We also analyzed the factors associated with stent recanalization. To our knowledge, this is the most comprehensive analysis comparing long-term outcomes after treatment of IAs with the LVIS or EP stent reported to date.

Section snippets

Patient Selection

We retrospectively collected data from consecutive patients who underwent placement of an LVIS or EP stent for the treatment of a ruptured or unruptured IA at our center between June 2014 and July 2015. All patients provided informed consent before undergoing treatment. The study protocol was approved by our institution's Ethics Committee.

Endovascular Procedure

All patients received dual-antiplatelet therapy (aspirin 100 mg/day and clopidogrel 75 mg/day) for at least 3–5 days before the procedure. Two groups of

Patient and Aneurysm Characteristics

Between June 2014 and July 2016, 142 patients with 161 IAs were treated by LVIS stent-assisted coiling, and 111 patients with 142 IAs were treated by EP stent-assisted coiling at our center. Baseline patient and aneurysm characteristics are presented in Tables 1 and 2.

There were significant differences between the 2 groups in terms of sex distribution, smoking history, and location of bifurcation. Between-group differences in patient age, antiplatelet drug resistance, aneurysm size, and

Discussion

Our study of 254 consecutive patients with IAs treated with either the LVIS or EP stent demonstrates acceptable rates of complete and near-complete occlusion with both types of stents. LVIS stents appeared to be associated with lower rates of recanalization and in-stent stenosis compared with the EP stents, although the differences were not significant. Higher SR (≥2) was significantly associated with recanalization in the EP group, but not in the LVIS group.

The endovascular treatment of

Conclusions

Our study has demonstrated acceptable rates of complete and near-complete occlusion with both the LVIS and EP stents. Although the LVIS stents appeared to have a lower rate of recanalization and in-stent stenosis than the EP stents, the difference was not significant. A higher SR (≥2) was significantly associated with recanalization in IAs treated with the EP stent, but not in those treated with the LVIS stent.

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    • Cited by (0)

    Conflict of interest statement: This work was supported by the Natural Science Foundation of Beijing (7142032), and Specific Research Projects for Capital Health Development (2014-3-2044). The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

    Xin Feng and Zenghui Qian contributed equally to this work.

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