Volume 4, Issue 1, March 2020, Page: 5-10
LVIS Blue as a Stand-alone “Flow Diverter”
Matthew Koch, Department of Neurosurgery, The Massachusetts General Hospital, Boston, The United States
Mehr Nasir-Moin, Department of Neurosurgery, The Massachusetts General Hospital, Boston, The United States
Scott Raymond, Department of Radiology, The University of Vermont Medical Center, Burlington, The United States
Christopher Stapleton, Department of Neurosurgery, The Massachusetts General Hospital, Boston, The United States
Thabele Leslie-Mazwi, Department of Neurosurgery, The Massachusetts General Hospital, Boston, The United States; Department of Neurology, Massachusetts General Hospital, Boston, The United States
James Rabinov, Department of Neurosurgery, The Massachusetts General Hospital, Boston, The United States; Department of Radiology, The Massachusetts General Hospital, Boston, The United States
Aman Patel, Department of Neurosurgery, The Massachusetts General Hospital, Boston, The United States
Received: Dec. 26, 2019;       Accepted: Jan. 10, 2020;       Published: Feb. 4, 2020
DOI: 10.11648/j.cnn.20200401.12      View  22      Downloads  39
Flow diversion fundamentally changes the treatment approach towards intracranial aneurysms. Most currently available devices established efficacy and safety data in the proximal anterior circulation; the distal and posterior circulations remain areas of active research. LVIS Blue is a stent with 28% metal coverage approved for use as a coil adjuvant. Some studies indicate potential “flow diverter” properties. We sought to evaluate the LVIS Blue as a stand-alone “flow diverter” for the treatment of intracranial aneurysms. We performed an observational single-center study to evaluate initial occlusion and occlusion at six months follow-up for patients with distal or posterior circulation aneurysms treated with the LVIS Blue as a “flow diverter” at our institution. Ten aneurysms were treated over the course of two years with six-month angiographic follow-up. Seven lesions were in the distal anterior circulation and were unruptured (five anterior communicating artery, one M2 middle cerebral artery, one pericallosal). Three were posterior circulation (two basilar tip aneurysms, one P2 posterior cerebral artery aneurysm). Follow up demonstrated treatment effect in nine of ten aneurysms (four complete aneurysm occlusions, five lesions with decreased size and flow). One lesion showed no treatment response. No ischemic or hemorrhagic complications were noted during placement or clinical follow-up. LVIS Blue can function safely as a “flow diverter” in the distal and posterior circulations. Further data regarding long-term efficacy is needed.
Aneurysm, LVIS, Stent, Embolization, Flow Diverter
To cite this article
Matthew Koch, Mehr Nasir-Moin, Scott Raymond, Christopher Stapleton, Thabele Leslie-Mazwi, James Rabinov, Aman Patel, LVIS Blue as a Stand-alone “Flow Diverter”, Clinical Neurology and Neuroscience. Vol. 4, No. 1, 2020, pp. 5-10. doi: 10.11648/j.cnn.20200401.12
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Szikora I, Berentei Z, Kulcsar Z, et al. Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the Budapest experience with the pipeline embolization device. American Journal of Neuroradiology. 2010; 31 (6): 1139-1147.
D'urso PI, Lanzino G, Cloft HJ, Kallmes DF. Flow diversion for intracranial aneurysms. Stroke. 2011; 42 (8): 2363-2368.
Phillips TJ, Wenderoth JD, Phatouros CC, et al. Safety of the Pipeline Embolization Device in Treatment of Posterior Circulation Aneurysms. American Journal of Neuroradiology. 2012; 33 (7): 1225-1231.
Chalouhi N, Tjoumakaris S, Dumont AS, et al. Treatment of posterior circulation aneurysms with the pipeline embolization device. Neurosurgery. 2013; 72 (6): 833-889.
Colby GP, Bender MT, Lin L-M, et al. Endovascular flow diversion for treatment of anterior communicating artery region cerebral aneurysms: a single-center cohort of 50 cases. Journal of NeuroInterventional Surgery. 2017; 9 (7): 679-685.
Griessenauer CJ, Ogilvy CS, Foreman PM, et al. Pipeline Embolization Device for Small Intracranial Aneurysms: Evaluation of Safety and Efficacy in a Multicenter Cohort. Neurosurgery. 2017; 80 (4): 579-587.
Griessenauer CJ, Ogilvy CS, Adeeb N, et al. Pipeline embolization of posterior circulation aneurysms: a multicenter study of 131 aneurysms. 2018: 1.
Primiani CT, Ren Z, Kan P, et al. A2, M2, P2 aneurysms and beyond: results of treatment with pipeline embolization device in 65 patients. Journal of NeuroInterventional Surgery. 2019: neurintsurg-2018-014631.
Rajah G, Narayanan S, Rangel-Castilla L. Update on flow diverters for the endovascular management of cerebral aneurysms. Neurosurg Focus. 2017; 42 (6): E2.
Chalouhi N, Zanaty M, Whiting A, et al. Safety and efficacy of the Pipeline Embolization Device in 100 small intracranial aneurysms. J Neurosurg. 2015; 122 (6): 1498-1502.
Raz E, Shapiro M, Becske T, et al. Anterior Choroidal Artery Patency and Clinical Follow-Up after Coverage with the Pipeline Embolization Device. American Journal of Neuroradiology. 2015; 36 (5): 937-942.
Koch MJ, Stapleton CJ, Raymond SB, et al. LVIS Blue as a low porosity stent and coil adjuvant. J Neurointerv Surg. 2018; 10 (7): 682-686.
O'Kelly CJ, Krings T, Fiorella D, Marotta TR. A Novel Grading Scale for the Angiographic Assessment of Intracranial Aneurysms Treated Using Flow Diverting Stents. Interventional Neuroradiology. 2010; 16 (2): 133-137.
Kamran M, Yarnold J, Grunwald IQ, Byrne JV. Assessment of angiographic outcomes after flow diversion treatment of intracranial aneurysms: a new grading schema. Neuroradiology. 2011; 53 (7): 501-508.
Grunwald IQ, Kamran M, Corkill RA, et al. Simple Measurement of Aneurysm Residual after Treatment: the SMART scale for evaluation of intracranial aneurysms treated with flow diverters. Acta Neurochirurgica. 2012; 154 (1): 21-26.
Mazur MD, Taussky P, Shah LM, Winegar B, Park MS. Inter-rater reliability of published flow diversion occlusion scales. Journal of NeuroInterventional Surgery. 2016; 8 (12): 1294-1298.
Fischer S, Vajda Z, Aguilar Perez M, Schmid E, Hopf N, Bazner H. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology. 2012; 54.
Becske T, Kallmes DF, Saatci I, et al. Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial. Radiology. 2013; 267 (3): 858-868.
Siddiqui AH, Kan P, Abla AA, Hopkins LN, Levy EI. Complications after treatment with pipeline embolization for giant distal intracranial aneurysms with or without coil embolization. Neurosurgery. 2012; 71 (2): E509-E513.
Raphaeli G, Collignon L, De Witte O, Lubicz B. Endovascular treatment of posterior circulation fusiform aneurysms: single-center experience in 31 patients. Neurosurgery. 2011; 69 (2): 274-283.
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. Journal of NeuroInterventional Surgery. 2017: neurintsurg-2017-013074.
Wang C, Tian Z, Liu J, et al. Flow diverter effect of LVIS stent on cerebral aneurysm hemodynamics: a comparison with Enterprise stents and the Pipeline device. Journal of Translational Medicine. 2016; 14 (1): 199.
Lim YC, Shin YS, Chung J. Flow Diversion via LVIS Blue Stent within Enterprise Stent in Patients with Vertebral Artery Dissecting Aneurysm. World Neurosurgery. 2018; 117: 203-207.
Gupta R, Ogilvy CS, Moore JM, et al. Proposal of a follow-up imaging strategy following Pipeline flow diversion treatment of intracranial aneurysms. 2018: 1.
Hong B, Wang K, Huang Q, et al. Effects of metal coverage rate of flow diversion device on neointimal growth at side branch ostium and stented artery: an animal experiment in rabbit abdominal aorta. Neuroradiology. 2012; 54 (8): 849-855.
Mut F, Cebral JR. Effects of Flow-Diverting Device Oversizing on Hemodynamics Alteration in Cerebral Aneurysms. American Journal of Neuroradiology. 2012; 33 (10): 2010-2016.
Shapiro M, Raz E, Becske T, Nelson PK. Variable Porosity of the Pipeline Embolization Device in Straight and Curved Vessels: A Guide for Optimal Deployment Strategy. American Journal of Neuroradiology. 2014; 35 (4): 727-733.
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