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A, Aneurysm of the cavernous internal carotid artery. B, Two microwires (.0014 inches), which make advancing the Leo stent easier. C, An implanted Leo stent.
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We report initial experience with the use of a new intracranial stent, the Leo microstent in combination with detachable coils in treatment of patients with wide-necked cerebral aneurysms. The Leo stent represents a significant advance in the vascular treatment of intracranial aneurysm with high radial force and an easy delivery system. It is a fea...
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To evaluate the safety and efficacy of stent placement for the treatment of complex intracranial aneurysms.
We searched six databases, including Pubmed, Embase, SCI-expanded, the Cochrane Library, ISI Proceedings and ProQuest Dissertations & Theses for the relevant studies using multiple key words from December, 1997 to February, 2009.
Thirty-three...
An infrequent occurrence during endovascular treatment is protusion of detachable coils into the parent lumen with a subsequent thrombosis within in the parent vessel or embolic events. We report the short- and intermediate-term angiographic and clinical outcomes of patients who experience coil or loop protrusions and are managed with medical or ad...
Citations
... This feature facilitates identification of the stent position and deployment. The LEO+ (Baby)™ can be placed through every 0.017″ microcatheter lumen, and stent sizes are available in diameters and lengths of 2.0 to 5.5 mm and 12 to 75 mm, respectively [6,8,9]. ...
Previous case series have described the safety and efficacy of different stent models for stent-assisted aneurysm coiling (SAC), but comparative analyses of procedural results are limited. This study investigates the procedural outcome and safety of three different stent models (Atlas™, LEO+™ (Baby) and Enterprise™) in the setting of elective SAC treated at a tertiary neuro-endovascular center. We retrospectively reviewed all consecutively treated patients that received endovascular SAC for intracranial aneurysms between 1 July 2013 and 31 March 2020, excluding all emergency angiographies for acute subarachnoid hemorrhage. The primary procedural outcome was the occlusion rate evaluated with the Raymond-Roy occlusion classification (RROC) assessed on digital subtraction angiography (DSA) at 6-and 12-month follow-up. Safety assessment included periprocedural adverse events (i.e., symptomatic ischemic complications, symptomatic intracerebral hemorrhage, iatrogenic perforation, dissection, or aneurysm rupture and in-stent thrombosis) and in-house mortality. Uni-and multivariable logistic regression analyses were performed to identify patient baseline and aneurysm characteristics that were associated with complete aneurysm obliteration at follow-up. A total of 156 patients undergoing endovascular treatment via SAC met the inclusion criteria. The median age was 62 years (IQR, 55-71), and 73.7% (115) of patients were female. At first follow-up (6-month) and last available follow-up (12 and 18 months), complete aneurysm occlusion was observed in 78.3% (90) and 76.9% (102) of patients, respectively. There were no differences regarding the occlusion rates stratified by stent model. Multivariable logistic analysis revealed increasing dome/neck ratio (adjusted odds ratio (aOR), 0.26.; 95% CI, 0.11-0.64; p = 0.003), increasing neck size (aOR, 0.70; 95% CI, 0.51-0.96; p = 0.027), and female sex (aOR, 4.37; 95% CI, 1.68-11.36; p = 0.002) as independently associated with treatment success. This study showed comparable rates of complete long-term aneurysm obliteration and safety following SAC for intracranial aneurysm with three different stent-models highlighting the procedural feasibility of this treatment strategy with currently available stent-models. Increased neck size and a higher dome/neck ratio were independent variables associated with less frequent complete aneurysm obliteration. Citation: Strittmatter, C.; Meyer, L.; Broocks, G.; Alexandrou, M.; Politi, M.; Boutchakova, M.; Henssler, A.; Reinges, M.; Simgen, A.; Papanagiotou, P.; et al. Procedural Outcome Following Stent-Assisted Coiling for Wide-Necked Aneurysms Using Three Different Stent Models: A Single-Center Experience.
... The introduction of specially designed self-expandable stents for intracranial use has significantly expanded the spectrum of endovascular aneurysm therapy. The first report on such a stent, the Neuroform, was published in 2002, others followed shortly thereafter 1,9,10 . ...
Intracranial stents have expanded endovascular therapy options for intracranial aneurysms. The braided Accero stent is available for clinical use since May 2015. To date, no clinical reports on the stent are available. Purpose of this study was the evaluation of the safety and efficacy of the Accero stent in stent-assisted coiling. All patients, in whom implantation of the stent was performed, were included. Primary endpoints were good clinical outcome (mRS ≤ 2) and aneurysm occlusion grades 1 and 2 (Raymond Roy Occlusion Classification). Secondary endpoints were procedural and device-related complications with permanent disability or death, complications in the course, and the recanalization rate. Between September 2015 and August 2018, thirty-four aneurysms were treated with stent-assisted coiling using the Accero. Sixteen aneurysms were untreated, four of these were ruptured. Mild neurological complications occurred in 2/34 (5.9%) treatments. Two stent occlusions occurred during follow-up. No patient had a poor procedure- or device-related outcome. After an average of 15 months of follow-up, 28/30 aneurysms were completely or near-completely occluded. The Accero stent proved to be safe and effective in the treatment of broad-based intracranial aneurysms. The complication rate and the rate of successful aneurysm occlusions are similar to those of other stents.
... The most widely used stents include the Neuroform system (Stryker) (7,8), the Enterprise Vascular Reconstruction Device (DePuy Synthes; Johnson & Johnson Medical Devices Companies) (9)(10)(11), Leo stent device (Balt Extrusion) (12,13) and Low-profile visualized intraluminal support (LVIS) stent (Medtronic plc). The LVIS stent is the most frequently used approach for treating wide-necked and other types of complex cerebral aneurysm (14). ...
The aim of the present study was to evaluate the safety and effectiveness of low-profile visualized intraluminal support (LVIS) stent and the pipeline embolization device (PED) for middle cerebral artery (MCA) aneurysm treatment. Data of patients with MCA aneurysms who received endovascular treatment with LVIS stent or PED added to the hospital's database between August 2016 and March 2018 were retrospectively collected, and the clinical results and angiographic outcomes were evaluated. A total of 43 patients were included in the study, of whom 23 received LVIS stents and 20 received PED. The rate of complete occlusion was similar in the two groups at 6 months post-treatment (90.9 vs. 88.9%; P=0.832). Peri-operative complications were more frequent in the PED group; however, the LVIS group had more ischemic symptoms during the long-term follow-up. A larger aneurysm size (P=0.032) was associated with recanalization in the two groups. In conclusion, the LVIS stent and PED had acceptable rates of complete occlusion and aneurysm size was an independent predictor for recanalization. LVIS is more effective during the peri-operative period, while PED appears to have higher long-term safety.
... The poor X-ray visibility of nitinol and the risk of stent kinking in significant curvatures were still limiting factors in some extent. The development of stents braided from nitinol wires including two or more helical radiopaque strands, provided a better visibility and control of position and wall apposition as well as an increased radial force [23,24]. Finally, the last-generation nitinol-braided microstents allow now to treat IA located on arteries as small as 1.5 mm that may be accessed with 0.0165" microcatheters [25][26][27][28]. ...
Introduction: Stent-assisted coiling (SAC) has widened indications of endovascular treatment of intracranial aneurysms (wide-neck, fusiform aneurysms); moreover, it is associated with more stable anatomical results. Besides the development of other techniques such as flow diverter stents, bifurcation stents or intrasaccular flow disruptors, SAC remains one of the most used endovascular techniques because it provides good clinical and anatomical results for most aneurysms. Several devices based on the same principle are available and have undergone many adaptations and developments over 20 years of intracranial stenting.
Areas covered: The purpose of this article is to review and compare intrinsic properties of available devices and their anatomical and clinical performance.
Expert Commentary: Based on this review and our experience of SAC, we will discuss the behavior and performance of those devices in different anatomic and clinical situations.
... Among self-expanding stents, the LEO stent (Balt) has existed for more than 15 years and has been shown to be safe and effective [10][11][12]. While long-term data have been published on other self-expanding stents [13][14][15][16][17][18], only one reference exists concerning long-term clinical and angiographic results with the Leo stent [19]. ...
PurposeCoiling associated with placement of a self-expandable intracranial stent has improved the treatment of intracranial wide-necked aneurysms. Little is known, however, about the durability of this treatment. The purpose of this report is to present our experience with the LEO stent and to evaluate the complications, effectiveness, and long-term results of this technique. Methods
We analyzed the records of 155 intracranial unruptured aneurysms that were treated by stent-assisted coiling with a LEO stent between 2008 and 2012. Procedural, early post-procedural, and delayed complications were recorded. Clinical and angiographic follow-up of patients was conducted over a period of at least 36 months. ResultsNo procedural mortality was observed. One-month morbidity was observed in 14 out of 153 patients (9,15%). One hundred thirty-eight patients (with 140 aneurysms) had clinical and angiographic follow-up for more than 36 months. No aneurysm rupture was observed during follow-up. Four patients presented an intra-stent stenosis at 8 months, and 6 patients who had an early recurrence were retreated. Final results showed 85% complete occlusion, 13% neck remnants, and 2% stable incomplete occlusion. Conclusion
Stent-assisted coiling with the LEO stent is a safe and effective treatment for unruptured intracranial aneurysms. The long-term clinical outcomes with the LEO stent are excellent with a high rate of complete occlusion that is stable over time.
... Among them, the Leo stent was the first available retrievable stent. Several authors have reported satisfying results with mid-to long-term follow-up with this device [9][10][11][12][13][14][15][16][17][18][19]. However, very long-term results are still missing in order to evaluate the stability of anatomical results as well as the tolerance of the stent over the years. ...
... Our study has included all our patients treated since 2004 with the Leo stent. Our failure rate is relatively low, despite our learning curve at the beginning, and it is comparable to previously published series [9][10][11][12][13][14][15][16][17][18][19]. In most cases, we have used the Leo stent as a support for coils. ...
... In the present study, we had no procedure-related permanent morbidity or mortality. These rates are comparable or even lower than those previously reported [9][10][11][12][13][14][15][16][17][18][19]. We think that two reasons may explain these good results: (1) a very strict antiplatelet medication that is frequently controlled by our neurovascular team before and after EVT and (2) our center is a referral hospital for complex IAs so that we now perform SAC in >200/250 IAs yearly treated at our institution. ...
IntroductionThe Leo stent was the first retrievable stent for endovascular treatment of intracranial aneurysms (IAs). We report our experience with this device with emphasis on very long-term follow-up. Methods
This study was approved by authors’ ethical committee. A retrospective review of our prospectively maintained database identified all patients treated for a saccular IA with this stent in our institution. Technical issues and immediate and long-term outcomes (at least 12 months) were evaluated. ResultsBetween 2004 and 2015, 50 patients with 52 IAs were identified. In two patients, the stent could not safely be placed (failure rate = 3.8%). Among 48 treated patients with 50 IAs, there were 44 women and 4 men (mean age, 53 years). Mean aneurysm diameter was 7.2 mm. All IAs but six were wide-necked. There was no immediate morbidity or mortality. Anatomical results included 76% complete occlusions, 22% neck remnants, and 2% incomplete occlusions. Mean follow-up was 50.2 months (range, 12–139 months). Two patients had delayed TIAs but long-term morbidity rate remained = 0%. At follow-up, occlusion was stable in 68% IAs, showed thrombosis in 12%, and recanalization in 20% IAs. Complementary treatment was required in 8% IAs. Final results showed 70% complete occlusions, 24% neck remnants, and 6% incomplete occlusions. Asymptomatic stent occlusion and significant stenosis occurred in one and two cases, respectively. Conclusion
The Leo stent is safe and effective for treatment of wide-necked saccular IAs. Very long-term results show high rates of adequate and stable occlusion. Moreover, the stent is well tolerated.
... Use of the Solitaire stent was considered when the diameter of the parent artery was >4.5 mm. However, the Solitaire stent provides a lower metal coverage rate and larger mesh [9], which can increase the risk of coil migration when small aneurysms are included [10]. Moreover, it is difficult to discern the exact position of the proximal edge of the working region of the Solitaire stent on an angiogram. ...
We performed this study to report our experience using a stepwise stent deployment technique for the treatment of tandem intracranial aneurysms.
Patients with intracranial tandem aneurysms that were treated with a stepwise stent deployment technique between May 2009 and June 2013 were retrospectively reviewed.
Twenty-one patients with 42 tandem aneurysms were identified (11 men, 10 women), with a mean age of 53.7 years (range, 17-82 years). Subarachnoid haemorrhage was confirmed in 12 patients using computed tomography at onset. Complete occlusion was achieved in 20 of the aneurysms (47.6 %) after the procedure, neck remnant in 9 (21.4 %), and aneurysm remnant in 13 (31.0 %). The perioperative complications included in-stent thrombosis in one case and vasospasm in two cases, none of which left a permanent neurological deficit. The modified Rankin Scale (mRS) score at discharge was 0-2 in 20 cases and 3 in one case. The follow-up angiograms available for 17 patients showed complete occlusion in 26 aneurysms, improved in 4, and stable in 4. All of the patients had mRS scores of 0-1 during the clinical follow-up period.
The stepwise stent deployment technique is feasible and helpful in the treatment of intracranial tandem aneurysms.
• Treating wide-necked intracranial aneurysms with stent-assisted coiling is preferable. • Tandem wide-necked intracranial aneurysms can be treated with a single stent. • Stepwise stent deployment is technically feasible for embolizing tandem intracranial aneurysms.
... Some authors have already addressed the difficulty of EVT and proposed some strategies for patients with marked tortuosity of the aortic arch and/or carotid artery in conjunction with intracranial aneurysm [1,2,8,12,13,15]. In our study, patients with ruptured aneurysms in which the parent artery presented with greater than 360° coiling of the external ICA, 13/14 cases were accompanied by an anomaly of the aortic arch of type II or type III. ...
... Although other studies had suggested that we use the Neuron 6F guiding catheter to have more distal access to the intracranial vessels for a more unrestricted microcatheterization, their experiences were primarily based upon cases where the catheter was passed through a tortuous ICA or intracranial vessels but without coiling [7,9,11,12,14]. We found it impossible to reach a distal position over the coiling of parent ICA without an 8F ENVOY guiding catheter as a shuttle sheath as it provided support that was essential for the proper placement of Neuron 6F guiding catheter. ...
To describe our initial experience and early outcomes with distal placement of the Neuron 6F guiding catheter through coiled ICA for aneurysmal EVT. We examined the utility of the Neuronf 70 6F guiding catheter for the embolization procedure in such cases, fourteen cases of aneurysm with coiling of the parent ICA are presented via traditional guiding catheters. With the support of 8F ENVOY guiding catheter as a shuttle sheath, the Neuron(TM) 70 6F guiding catheter was successfully placed through coiled extracranial ICA, so the mirocatheter could be delivered to a more strategic position for embolization of the aneurysm. Coiling of extracranial ICA was found as parent artery on angiogram in all patients with ruptured aneurysms. Even where there were two curvatures of more than 360° in the coiled segment of the ICA, Neuron(TM) 70 6F guiding catheter could be placed through the coiling to a distal position and enabled EVT of intracranial aneurysms with no related neurological complications. Neuron guiding catheter is a useful device for embolization of aneurysm where there is coiling of parent ICA, easily placed through the coiling of the ICA and provided robust anatomical support via enhanced catheter-to-vessel wall engagement.
... In an effort to improve angiographic outcome after embolization of large and wide-neck aneurysms, intracranial stents were introduced as mechanical support for coils (6,(12)(13)(14)(15) with a paradoxical result -stented aneurysms had a lower rate of immediate complete occlusion than only coiled aneurysms (16)(17)(18). Our results also displayed this trend -there was a significantly smaller percentage of completely occluded aneurysms and significantly greater percentage of aneurysms with residual filling of lumen in SAC than in NAC group. ...
Aim:
To compare angiographic result at long-term follow-up, and rates of progressive occlusion, recurrence, and retreatment of stent-assisted coiled (SAC) and non-assisted coiled (NAC) intracranial saccular aneurysms.
Methods:
Retrospective evaluation of department records identified 260 patients with 283 saccular intracranial aneurysms who had long-term angiographic follow-up (more than 12 months) and were successfully treated with SAC (89 aneurysms) or NAC (194 aneurysms) at the University Hospital Center Zagreb from June 2005 to July 2012. Initial and control angiographic results in both groups were graded using Roy/Raymond scale, converted to descriptive terms, and the differences between them were evaluated for statistical significance. A multivariate analysis was performed to identify factors related to progression of aneurysm occlusion and recurrence at follow-up, and those related to aneurysm retreatment.
Results:
There were more progressively occluded aneurysms in SAC group (38 of 89 aneurysms, 42.7%) than in NAC group (46 of 194, 23.7%) (P=0.002), but there were no significant differences in the rates of recanalization, regrowth, and stable result. Multivariate logistic regression identified the use of stent as the most important factor associated with progressive occlusion (P=0.015, odds ratio 2.22, 95% confidence interval 1.17-4.21), and large aneurysm size and posterior circulation location as most predictive of aneurysm recurrence and retreatment.
Conclusion:
The use of stent is associated with delayed occlusion of initially incompletely coiled aneurysms during follow-up, but does not reduce the rate of recurrence and retreatment compared to coiling alone. Long-term angiographic follow-up is needed for both SAC and NAC aneurysms.
... Flow-diverting devices consist of a flexible, microcatheter-delivered, self-expanding, endovascular "stentlike" construct intended to create a laminar flow pattern in the parent artery and secondary thrombosis within the aneurysm, while keeping open the arterial perforators. 21 Patients in this case series were treated with either Pipeline or Silk devices, the latter partially in a "telescoping technique," 22 combining LEO (Balt Extrusion) and Silk stents (Table 1). ...
Fusiform vertebrobasilar giant aneurysms are a rare (<1% of all intracranial aneurysms) but challenging aneurysm subtype. Little data are available on the natural history of this aneurysm subtype and the impact of the use of flow-diverting stents on the long-term clinical and imaging follow-up. In this article, we present our experience with the treatment of fusiform vertebrobasilar giant aneurysms by flow diverting stents. We aim to stimulate a discussion of the best management paradigm for this challenging aneurysm subtype.
We retrospectively identified 6 patients with fusiform vertebrobasilar giant aneurysms who had been treated with flow-diverting stents between October 2009 and March 2012 in our center. The available data were re-evaluated. The modified Rankin Scale score was assessed before intervention, during the stay in hospital, and at discharge.
Six patients were identified (all male; age range, 49-71 years; median age, 60 years). Handling of material was successful in all cases. No primary periprocedural complications occurred. The mean follow-up was 13 months (15 days to 29 months). During follow-up, 3 of 6 patients had recurrent cerebral infarctions, but no patient experienced SAH. Two patients presented with acute thrombotic stent occlusion. The modified Rankin Scale score was not higher than 3 in any of the cases before intervention, whereas the best mRS score at the last follow-up was 5. Four of 6 patients died during follow-up.
Endovascular treatment of fusiform vertebrobasilar giant aneurysms with flow-diverting devices is feasible from a technical point of view; however, changes in hemodynamics with secondary thrombosis are not predictable. We currently do not intend to treat fusiform vertebrobasilar giant aneurysms with flow-diverting devices until we have further understanding of the pathophysiology, natural history, and hemodynamic effects of flow diversion.
