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Original article
peer-reviewed

Low-profile Visualized Intraluminal Support Junior Device for the Treatment of Intracranial Aneurysms



Abstract

Objective: Early case series suggest that the recently introduced Low-profile Visualized Intraluminal Support Junior (LVIS Jr.) device (MicroVention-Terumo, Inc., Tustin, CA) may be used to treat wide-necked aneurysms that would otherwise require treatment with intrasaccular devices or open surgery. We report our single-center experience utilizing LVIS Jr. to treat intracranial aneurysms involving 1.8-2.5 mm parent arteries.

Methods: We retrospectively reviewed records of patients treated with the LVIS Jr. device for intracranial aneurysms at a single center. A total of 21 aneurysms were treated in 18 patients. Aneurysms were 2-25 mm in diameter; one was ruptured, while three had recurred after previous rupture and treatment. Lesions were distributed across the anterior (n=12) and posterior (n=9) circulations. Three were fusiform morphology.

Results: Stent deployment was successful in 100% of cases with no immediate complications. Seventeen aneurysms were treated with stent-assisted coil embolization resulting in immediate complete occlusion in 94% of cases. Two fusiform aneurysms arising from the posterior circulation were further treated with elective clip ligation after delayed expansion and recurrence; no lesions required further endovascular treatment. Four aneurysms were treated by flow diversion with stand-alone LVIS Jr. stent, and complete occlusion was achieved in three cases. Small foci of delayed ischemic injury were noted in two patients in the setting of antiplatelet medication noncompliance. No in-stent stenosis, migration, hemorrhage, or permanent deficits were observed. Good functional outcome based on the modified Rankin Scale score (mRS ≤ 2) was achieved in 100% of cases.

Conclusion: Our midterm results suggest that the LVIS Jr. stent may be used for a variety of intracranial aneurysms involving small parent arteries (1.8-2.5 mm) with complete angiographic occlusion, parent vessel preservation, and functional clinical outcomes. This off-label expansion would increase the number of aneurysms amenable to endovascular treatment. Future studies may build upon our experiences with flow diversion and treatment of complex or multiple lesions.



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Original article
peer-reviewed

Low-profile Visualized Intraluminal Support Junior Device for the Treatment of Intracranial Aneurysms


Author Information

Mihir Gupta

Department of Neurosurgery, University of California, San Diego

Vincent J. Cheung

Department of Neurosurgery, University of California, San Diego

Peter Abraham

Department of Neurosurgery, University of California, San Diego

Arvin R. Wali

Department of Neurosurgery, University of California, San Diego

David R. Santiago-Dieppa Corresponding Author

Department of Neurosurgery, University of California, San Diego

Brandon C. Gabel

Department of Neurosurgery, University of California, San Diego

Abdulrahman Almansouri

Department of Neurosurgery, Royal College of Surgeons

J. Scott Pannell

Department of Neurosurgery, University of California, San Diego

Alexander A. Khalessi

Department of Neurosurgery, University of California, San Diego


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Surgical Outcomes after Neurovascular Interventions issued approval 161794. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Payment/services info: Arvin Wali is through the NIH TL1 predoctoral grant, grant #1TL1TR001443. Financial relationships: J. Scott Pannell MD and Alexander A Khalessi declare(s) personal fees from MicroVention. Consultancy (minimal conflict < $10,000).


Original article
peer-reviewed

Low-profile Visualized Intraluminal Support Junior Device for the Treatment of Intracranial Aneurysms


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Original article
peer-reviewed

Low-profile Visualized Intraluminal Support Junior Device for the Treatment of Intracranial Aneurysms

  • Author Information
    Mihir Gupta

    Department of Neurosurgery, University of California, San Diego

    Vincent J. Cheung

    Department of Neurosurgery, University of California, San Diego

    Peter Abraham

    Department of Neurosurgery, University of California, San Diego

    Arvin R. Wali

    Department of Neurosurgery, University of California, San Diego

    David R. Santiago-Dieppa Corresponding Author

    Department of Neurosurgery, University of California, San Diego

    Brandon C. Gabel

    Department of Neurosurgery, University of California, San Diego

    Abdulrahman Almansouri

    Department of Neurosurgery, Royal College of Surgeons

    J. Scott Pannell

    Department of Neurosurgery, University of California, San Diego

    Alexander A. Khalessi

    Department of Neurosurgery, University of California, San Diego


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Surgical Outcomes after Neurovascular Interventions issued approval 161794. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Payment/services info: Arvin Wali is through the NIH TL1 predoctoral grant, grant #1TL1TR001443. Financial relationships: J. Scott Pannell MD and Alexander A Khalessi declare(s) personal fees from MicroVention. Consultancy (minimal conflict < $10,000).

    Acknowledgements


    Article Information

    Published: February 17, 2017

    DOI

    10.7759/cureus.1037

    Cite this article as:

    Gupta M, Cheung V J, Abraham P, et al. (February 17, 2017) Low-profile Visualized Intraluminal Support Junior Device for the Treatment of Intracranial Aneurysms. Cureus 9(2): e1037. doi:10.7759/cureus.1037

    Publication history

    Received by Cureus: February 06, 2017
    Peer review began: February 09, 2017
    Peer review concluded: February 10, 2017
    Published: February 17, 2017

    Copyright

    © Copyright 2017
    Gupta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Objective: Early case series suggest that the recently introduced Low-profile Visualized Intraluminal Support Junior (LVIS Jr.) device (MicroVention-Terumo, Inc., Tustin, CA) may be used to treat wide-necked aneurysms that would otherwise require treatment with intrasaccular devices or open surgery. We report our single-center experience utilizing LVIS Jr. to treat intracranial aneurysms involving 1.8-2.5 mm parent arteries.

Methods: We retrospectively reviewed records of patients treated with the LVIS Jr. device for intracranial aneurysms at a single center. A total of 21 aneurysms were treated in 18 patients. Aneurysms were 2-25 mm in diameter; one was ruptured, while three had recurred after previous rupture and treatment. Lesions were distributed across the anterior (n=12) and posterior (n=9) circulations. Three were fusiform morphology.

Results: Stent deployment was successful in 100% of cases with no immediate complications. Seventeen aneurysms were treated with stent-assisted coil embolization resulting in immediate complete occlusion in 94% of cases. Two fusiform aneurysms arising from the posterior circulation were further treated with elective clip ligation after delayed expansion and recurrence; no lesions required further endovascular treatment. Four aneurysms were treated by flow diversion with stand-alone LVIS Jr. stent, and complete occlusion was achieved in three cases. Small foci of delayed ischemic injury were noted in two patients in the setting of antiplatelet medication noncompliance. No in-stent stenosis, migration, hemorrhage, or permanent deficits were observed. Good functional outcome based on the modified Rankin Scale score (mRS ≤ 2) was achieved in 100% of cases.

Conclusion: Our midterm results suggest that the LVIS Jr. stent may be used for a variety of intracranial aneurysms involving small parent arteries (1.8-2.5 mm) with complete angiographic occlusion, parent vessel preservation, and functional clinical outcomes. This off-label expansion would increase the number of aneurysms amenable to endovascular treatment. Future studies may build upon our experiences with flow diversion and treatment of complex or multiple lesions.



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Mihir Gupta

Department of Neurosurgery, University of California, San Diego

Vincent J. Cheung

Department of Neurosurgery, University of California, San Diego

Peter Abraham

Department of Neurosurgery, University of California, San Diego

Arvin R. Wali

Department of Neurosurgery, University of California, San Diego

David R. Santiago-Dieppa

Department of Neurosurgery, University of California, San Diego

For correspondence:
drsantiagodieppa@ucsd.edu

Brandon C. Gabel

Department of Neurosurgery, University of California, San Diego

Abdulrahman Almansouri

Department of Neurosurgery, Royal College of Surgeons

J. Scott Pannell

Department of Neurosurgery, University of California, San Diego

Alexander A. Khalessi

Department of Neurosurgery, University of California, San Diego

Mihir Gupta

Department of Neurosurgery, University of California, San Diego

Vincent J. Cheung

Department of Neurosurgery, University of California, San Diego

Peter Abraham

Department of Neurosurgery, University of California, San Diego

Arvin R. Wali

Department of Neurosurgery, University of California, San Diego

David R. Santiago-Dieppa

Department of Neurosurgery, University of California, San Diego

For correspondence:
drsantiagodieppa@ucsd.edu

Brandon C. Gabel

Department of Neurosurgery, University of California, San Diego

Abdulrahman Almansouri

Department of Neurosurgery, Royal College of Surgeons

J. Scott Pannell

Department of Neurosurgery, University of California, San Diego

Alexander A. Khalessi

Department of Neurosurgery, University of California, San Diego