Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of Stent Apposition in the LVIS Blue Stent-Assisted Coiling of Distal Internal Carotid Artery Aneurysms : Correlation with Clinical and Angiographic Outcomes

  • Kwon, Min-Yong (Department of Neurosurgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine) ;
  • Ko, Young San (Department of Neurosurgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine) ;
  • Kwon, Sae Min (Department of Neurosurgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine) ;
  • Kim, Chang-Hyun (Department of Neurosurgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine) ;
  • Lee, Chang-Young (Department of Neurosurgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine)
  • Received : 2022.02.03
  • Accepted : 2022.05.11
  • Published : 2022.11.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : To evaluate the stent apposition of a low-profile visualized intraluminal support (LVIS) device in distal internal carotid artery (ICA) aneurysms, examine its correlation with clinical and angiographic outcomes, and determine the predictive factors of ischemic adverse events (IAEs) related to stent-assisted coiling. Methods : We retrospectively analyzed a prospectively maintained database of 183 patients between January 2017 and February 2020. The carotid siphon from the cavernous ICA to the ICA terminus was divided into posterior, anterior, and superior bends. The anterior bends were categorized into angled (V) and non-angled (C, U, and S) types depending on the morphology and measured angles. Complete stent apposition (CSA) and incomplete stent apposition (ISA) were evaluated using unsubtracted angiography and flat-panel detector computed tomography. Dual antiplatelet therapy with aspirin 200 mg and clopidogrel 75 mg was administered. Clopidogrel resistance was defined as fewer responders (≥10%, <40%) and non-responders (<10%) based on the percent inhibition (%INH) of the VerifyNow system. These were counteracted by a dose escalation to 150 mg for fewer responders or substitution with cilostazol 200 mg for non-responders. IAEs included intraoperative in-stent thrombosis, transient ischemic attack, cerebral infarction, and delayed in-stent stenosis. A multivariate logistic regression analysis was used to determine the predictive factors for ISA and IAEs. Results : There were 33 ISAs (18.0%) and 27 IAEs (14.8%). The anterior bend angle was narrower in ISA (-4.16°±25.18°) than in CSA (23.52°±23.13°) (p<0.001). The V- and S-types were independently correlated with the ISA (p<0.001). However, treatment outcomes, including IAEs (15.3% vs. 12.1%), aneurysmal complete occlusion (91.3% vs. 88.6%), and recanalization (none of them), did not differ between CSA and ISA (p>0.05). The %INH of 27 IAEs (13.78%±14.78%) was significantly lower than that of 156 non-IAEs (26.82%±20.23%) (p<0.001). Non-responders to clopidogrel were the only significant predictive factor for IAEs (p=0.001). Conclusion : The angled and tortuous anatomical peculiarity of the carotid siphon caused ISA of the LVIS device; however, it did not affect clinical and angiographic outcomes, while the non-responders to clopidogrel affected the IAEs related to stent-assisted coiling.

Keywords

References

  1. Benndorf G, Strother CM, Claus B, Naeini R, Morsi H, Klucznik R, et al. : Angiographic CT in cerebrovascular stenting. AJNR Am J Neuroradiol 26 : 1813-1818, 2005
  2. Bouillot P, Brina O, Ouared R, Yilmaz H, Farhat M, Erceg G, et al. : Geometrical deployment for braided stent. Med Image Anal 30 : 85-94, 2016 https://doi.org/10.1016/j.media.2016.01.006
  3. Cho YD, Sohn CH, Kang HS, Kim JE, Cho WS, Hwang G, et al. : Coil embolization of intracranial saccular aneurysms using the low-profile visualized intraluminal support (LVISTM) device. Neuroradiology 56 : 543-551, 2014 https://doi.org/10.1007/s00234-014-1363-x
  4. Chung J, Matsuda Y, Nelson J, Keigher K, Lopes DK : A new low-profile visualized intraluminal support (LVIS) device, LVIS Blue: laboratory comparison between old and new LVIS. Neurol Res 40 : 78-85, 2018 https://doi.org/10.1080/01616412.2017.1398881
  5. Dholakia RJ, Kappel AD, Pagano A, Woo HH, Lieber BB, Fiorella DJ, et al. : In vitro angiographic comparison of the flow-diversion performance of five neurovascular stents. Interv Neuroradiol 24 : 150-161, 2018 https://doi.org/10.1177/1591019917748317
  6. Dumont TM, Eller JL, Mokin M, Sorkin GC, Levy EI : Advances in endovascular approaches to cerebral aneurysms. Neurosurgery 74 Suppl 1 : S17-S31, 2014 https://doi.org/10.1227/NEU.0000000000000217
  7. Fiorella D, Arthur A, Boulos A, Diaz O, Jabbour P, Pride L, et al. : Final results of the US humanitarian device exemption study of the low-profile visualized intraluminal support (LVIS) device. J Neurointerv Surg 8 : 894-897, 2016 https://doi.org/10.1136/neurintsurg-2015-011937
  8. Gurbel PA, Bliden KP, Butler K, Tantry US, Gesheff T, Wei C, et al. : Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation 120 : 2577-2585, 2009 https://doi.org/10.1161/CIRCULATIONAHA.109.912550
  9. Ha EJ, Cho WS, Kim JE, Cho YD, Choi HH, Kim T, et al. : Prophylactic antiplatelet medication in endovascular treatment of intracranial aneurysms: low-dose prasugrel versus clopidogrel. AJNR Am J Neuroradiol 37 : 2060-2065, 2016 https://doi.org/10.3174/ajnr.A4864
  10. Heller RS, Malek AM : Parent vessel size and curvature strongly influence risk of incomplete stent apposition in enterprise intracranial aneurysm stent coiling. AJNR Am J Neuroradiol 32 : 1714-1720, 2011 https://doi.org/10.3174/ajnr.A2584
  11. Heller RS, Malek AM : Delivery technique plays an important role in determining vessel wall apposition of the enterprise self-expanding intracranial stent. J Neurointerv Surg 3 : 340-343, 2011 https://doi.org/10.1136/jnis.2010.004499
  12. Heller RS, Miele WR, Do-Dai DD, Malek AM : Crescent sign on magnetic resonance angiography revealing incomplete stent apposition: correlation with diffusion-weighted changes in stent-mediated coil embolization of aneurysms. J Neurosurg 115 : 624-632, 2011 https://doi.org/10.3171/2011.4.JNS102050
  13. Hwang G, Huh W, Lee JS, Villavicencio JB, Villamor RB Jr, Ahn SY, et al. : Standard vs modified antiplatelet preparation for preventing thromboembolic events in patients with high on-treatment platelet reactivity undergoing coil embolization for an unruptured intracranial aneurysm: a randomized clinical trial. JAMA Neurol 72 : 764-772, 2015 https://doi.org/10.1001/jamaneurol.2015.0654
  14. Ikeda H, Otsuka R, Uesaka D, Sano N, Torikoshi S, Hayase M, et al. : Effects of acute angle, proximal bending, and distal bending in the deployment vessels on incomplete low-profile visualized intraluminal support (LVIS) expansion: an in vitro study. J Neurointerv Surg 13 : 453-458, 2021 https://doi.org/10.1136/neurintsurg-2020-016290
  15. Iosif C, Piotin M, Saleme S, Barreau X, Sedat J, Chau Y, et al. : Safety and effectiveness of the low profile visualized intraluminal support (LVIS and LVIS Jr) devices in the endovascular treatment of intracranial aneurysms: results of the TRAIL multicenter observational study. J Neurointerv Surg 10 : 675-681, 2018 https://doi.org/10.1136/neurintsurg-2017-013375
  16. Jankowitz BT, Gross BA, Seshadhri S, Girdhar G, Jadhav A, Jovin TG, et al. : Hemodynamic differences between pipeline and coil-adjunctive intracranial stents. J Neurointerv Surg 11 : 908-911, 2019 https://doi.org/10.1136/neurintsurg-2018-014439
  17. Kim CH, Hwang G, Kwon OK, Ban SP, Chinh ND, Tjahjadi M, et al. : P2Y12 reaction units threshold for implementing modified antiplatelet preparation in coil embolization of unruptured aneurysms: a prospective validation study. Radiology 282 : 542-551, 2017 https://doi.org/10.1148/radiol.2016160542
  18. Kim HJ, Oh JS, Park SQ, Yoon SM, Ahn HS, Kim BT : The efficacy of P2Y12 reactive unit to predict the periprocedural thromboembolic and hemorrhagic complications according to clopidogrel responsiveness and safety of modification of dual antiplatelet therapy : a meta-analysis. J Korean Neurosurg Soc 63 : 539-549, 2020 https://doi.org/10.3340/jkns.2019.0082
  19. Kim YD, Kwon OK, Ban SP, Won YD, Bang JS, Kim T, et al. : The inhibition rate estimated using verifynow can help to predict the thromboembolic risk of coil embolization for unruptured intracranial aneurysms. J Neurointerv Surg 14 : 589-592, 2022
  20. Koch MJ, Stapleton CJ, Raymond SB, Williams S, Leslie-Mazwi TM, Rabinov JD, et al. : LVIS Blue as a low porosity stent and coil adjuvant. J Neurointerv Surg 10 : 682-686, 2018 https://doi.org/10.1136/neurintsurg-2017-013608
  21. Mascitelli JR, Moyle H, Oermann EK, Polykarpou MF, Patel AA, Doshi AH, et al. : An update to the raymond-roy occlusion classification of intracranial aneurysms treated with coil embolization. J Neurointerv Surg 7 : 496-502, 2015 https://doi.org/10.1136/neurintsurg-2014-011258
  22. Matsuda Y, Chung J, Keigher K, Lopes D : A comparison between the new Low-profile Visualized Intraluminal Support (LVIS Blue) stent and the Flow Redirection Endoluminal Device (FRED) in bench-top and cadaver studies. J Neurointerv Surg 10 : 274-278, 2018 https://doi.org/10.1136/neurintsurg-2017-013074
  23. Mokin M, Primiani CT, Ren Z, Piper K, Fiorella DJ, Rai AT, et al. : Stentassisted coiling of cerebral aneurysms: multi-center analysis of radiographic and clinical outcomes in 659 patients. J Neurointerv Surg 12 : 289-297, 2020 https://doi.org/10.1136/neurintsurg-2019-015182
  24. Rouchaud A, Ramana C, Brinjikji W, Ding YH, Dai D, Gunderson T, et al. : Wall apposition is a key factor for aneurysm occlusion after flow diversion: a histologic evaluation in 41 rabbits. AJNR Am J Neuroradiol 37 : 2087-2091, 2016 https://doi.org/10.3174/ajnr.A4848
  25. Waihrich E, Clavel P, Mendes GAC, Iosif C, Moraes Kessler I, Mounayer C : Influence of carotid siphon anatomy on brain aneurysm presentation. AJNR Am J Neuroradiol 38 : 1771-1775, 2017 https://doi.org/10.3174/ajnr.A5285
  26. Waihrich E, Clavel P, Mendes G, Iosif C, Kessler IM, Mounayer C : Influence of anatomic changes on the outcomes of carotid siphon aneurysms after deployment of flow-diverter stents. Neurosurgery 83 : 1226-1233, 2018 https://doi.org/10.1093/neuros/nyx618
  27. Wang C, Tian Z, Liu J, Jing L, Paliwal N, Wang S, et al. : Flow diverter effect of LVIS stent on cerebral aneurysm hemodynamics: a comparison with Enterprise stents and the Pipeline device. J Transl Med 14 : 199, 2016 https://doi.org/10.1186/s12967-016-0959-9
  28. Wanke I, Forsting M : Stents for intracranial wide-necked aneurysms: more than mechanical protection. Neuroradiology 50 : 991-998, 2008 https://doi.org/10.1007/s00234-008-0460-0
  29. Wu P, Ocak PE, Wang D, Ocak U, Xu S, Li Y, et al. : Endovascular treatment of ruptured tiny intracranial aneurysms with low-profile visualized intraluminal support device. J Stroke Cerebrovasc Dis 28 : 330-337, 2019 https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.09.052
  30. Yuki I, Ishibashi T, Dahmani C, Kato N, Ikemura A, Abe Y, et al. : Combination of high-resolution cone beam computed tomography and metal artefact reduction software: a new image fusion technique for evaluating intracranial stent apposition after aneurysm treatment. BMJ Case Rep 12 : e230687, 2019 https://doi.org/10.1136/bcr-2019-230687
  31. Zhang C, Pu F, Li S, Xie S, Fan Y, Li D : Geometric classification of the carotid siphon: association between geometry and stenoses. Surg Radiol Anat 35 : 385-394, 2013 https://doi.org/10.1007/s00276-012-1042-8
  32. Zhang H, Gao X, Liang H, Ren Y : Incomplete stent apposition of lowprofile visualized intraluminal support stents in the treatment of cerebral aneurysms. J Neurointerv Surg 12 : 591-597, 2020 https://doi.org/10.1136/neurintsurg-2019-015505
  33. Zhang X, Zhong J, Gao H, Xu F, Bambakidis NC : Endovascular treatment of intracranial aneurysms with the LVIS device: a systematic review. J Neurointerv Surg 9 : 553-557, 2017 https://doi.org/10.1136/neurintsurg-2016-012403