Login Register Cart 0
Generic placeholder image

Current Neurovascular Research

Editor-in-Chief

ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

The Safety and Efficacy of Leo Stents with Coiling or Alone for Anterior Cerebral Artery Aneurysms

Author(s): Yu Duan*, Jun Shen*, Xuanfeng Qin, Binbin Xu, Renling Mao, Jian Li, Qinzhu An, Yujun Liao, Fayong Zhang and Gong Chen*

Volume 20, Issue 5, 2023

Published on: 12 December, 2023

Page: [560 - 567] Pages: 8

DOI: 10.2174/0115672026271147231130111233

Price: $65

Open Access Journals Promotions 2
conference banner
Abstract

Introduction: Treatment of anterior cerebral artery (ACA) aneurysms is still not well established. The Leo stent with blood flow direction is a retrievable stent for intracranial aneurysms, whereas it needs to be studied clearly in patients with ACA aneurysms.

Methods: Consecutive patients with ACA aneurysms were retrospectively enrolled in three neurosurgical centers between January 2016 and October 2021. The data on demographics, aneurysm characteristics, symptom resolution, and postoperative course were collected and analyzed. The aneurysm occlusion status was appraised by Raymond-Ray Occlusion Class (RROC).

Results: A total of 57 patients with ACA aneurysms were included in our study. Immediate postprocedural angiograms showed that 20 aneurysms (35.1%) were in complete occlusion (RROC 1), 26 aneurysms (45.6%) were in near-complete occlusion (RROC 2), 11 aneurysms (19.3%) were in incomplete occlusion (RROC 3). The angiographic follow-up found that the rate of complete occlusion increased to 57.9%, and near-completion and incomplete occlusion dropped to 29.8% and 12.3%, respectively. The angiographic result of the last follow-up improved significantly (Z=- 2.805, P=0.005). Univariate analysis indicated that distal location of aneurysms (Z=4.538, P=0.033) and ruptured aneurysms (χ2=.6120, P=0.032) were potential risk factors for intra-parent artery narrowing. Furthermore, multivariate logistic regression analysis found that A3 aneurysms (95% CI 1.427~32.744, P=0.016) are the key risk factor for intra-parent artery narrowing.

Conclusions: The Leo stent is safe and effective for aneurysms located in ACA circulations. The overall occlusion degree improved during follow-up. A distal, small artery was the risk factor for intra-parent artery narrowing.

Keywords: Endovascular treatment, aneurysm, stent, coiling, artery, risk factor.

« Previous Next »
[1]
Limbucci N, Leone G, Renieri L, et al. Expanding indications for flow diverters: Distal aneurysms, bifurcation aneurysms, small aneurysms, previously coiled aneurysms and clipped aneurysms, and carotid cavernous fistulas. Neurosurgery 2020; 86 (Suppl. 1): S85-94.
[http://dx.doi.org/10.1093/neuros/nyz334] [PMID: 31838532]
[2]
Bender MT, Zarrin DA, Campos JK, et al. Tiny pipes: 67 cases of flow diversion for aneurysms in distal vessels measuring less than 2.0 mm. World Neurosurg 2019; 127: e193-201.
[http://dx.doi.org/10.1016/j.wneu.2019.02.204] [PMID: 30878751]
[3]
Furtado SV, Jayakumar D, Perikal PJ, Mohan D. Contemporary management of distal anterior cerebral artery aneurysms: A dual-trained neurosurgeon’s perspective. J Neurosci Rural Pract 2021; 12(4): 711-7.
[http://dx.doi.org/10.1055/s-0041-1735823] [PMID: 34737505]
[4]
Atallah E, Saad H, Mouchtouris N, et al. Pipeline for distal cerebral circulation aneurysms. Neurosurgery 2019; 85(3): E477-84.
[http://dx.doi.org/10.1093/neuros/nyz038] [PMID: 30892649]
[5]
Takeuchi M, Uyama A, Matsumoto T, Tsuto K. Endovascular treatment for anterior communicating artery aneurysms. Adv Tech Stand Neurosurg 2022; 44: 239-49.
[http://dx.doi.org/10.1007/978-3-030-87649-4_13] [PMID: 35107683]
[6]
Cho S, Jo W, Jo Y, Yang KH, Park JC, Lee DH. Bench-top comparison of physical properties of 4 commercially-available self-expanding intracranial stents. Neurointervention 2017; 12(1): 31-9.
[http://dx.doi.org/10.5469/neuroint.2017.12.1.31] [PMID: 28316867]
[7]
Cagnazzo F, Cappucci M, Dargazanli C, et al. Flow-diversion effect of LEO stents: Aneurysm occlusion and flow remodeling of covered side branches and perforators. AJNR Am J Neuroradiol 2018; 39(11): 2057-63.
[http://dx.doi.org/10.3174/ajnr.A5803] [PMID: 30287459]
[8]
Pumar JM, Arias-Rivas S, Rodríguez-Yáñez M, et al. Using leo plus stent as flow diverter and endoluminal remodeling in endovascular treatment of intracranial fusiform aneurysms. J Neurointerv Surg 2013; 5 (Suppl. 3): iii22-7.
[http://dx.doi.org/10.1136/neurintsurg-2013-010661] [PMID: 23585639]
[9]
Aydin K, Barburoglu M, Sencer S, Berdikhojayev M, Coskun B, Akpek S. Flow diversion with low-profile braided stents for the treatment of very small or uncoilable intracranial aneurysms at or distal to the circle of willis. AJNR Am J Neuroradiol 2017; 38(11): 2131-7.
[http://dx.doi.org/10.3174/ajnr.A5362] [PMID: 28882859]
[10]
Aydin K, Arat A, Sencer S, Barburoglu M, Men S. Stent-assisted coiling of wide-neck intracranial aneurysms using low-profile leo baby stents: Initial and midterm results. AJNR Am J Neuroradiol 2015; 36(10): 1934-41.
[http://dx.doi.org/10.3174/ajnr.A4355] [PMID: 26021624]
[11]
Luecking H, Struffert T, Goelitz P, et al. Stent-assisted coiling using leo+ baby stent. Clin Neuroradiol 2021; 31(2): 409-16.
[http://dx.doi.org/10.1007/s00062-020-00904-3] [PMID: 32385517]
[12]
Pumar JM, Sucasas P, Mosqueira A, Vega P, Murias E. Five-years angiographic follow-up of wide-neck intracranial aneurysms treated with LEO plus stent. Front Neurol 2021; 12744962
[http://dx.doi.org/10.3389/fneur.2021.744962] [PMID: 34899568]
[13]
Cagnazzo F, Fanti A, Lefevre PH, et al. Distal anterior cerebral artery aneurysms treated with flow diversion: experience of a large-volume center and systematic review of the literature. J Neurointerv Surg 2021; 13(1): 42-8.
[http://dx.doi.org/10.1136/neurintsurg-2020-015980] [PMID: 32457222]
[14]
Sorenson TJ, Mendes Pereira V, Rangel Castilla L, Hilditch CA, Nicholson PJ, Brinjikji W. Treatment of anterior cerebral artery and anterior communicating artery aneurysms with flow-diversion devices: a systematic review and meta-analysis. J Neurosurg Sci 2020; 64(2): 200-5.
[http://dx.doi.org/10.23736/S0390-5616.18.04633-7] [PMID: 30620164]
[15]
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. AJNR Am J Neuroradiol 2014; 35(4): 727-33.
[http://dx.doi.org/10.3174/ajnr.A3742] [PMID: 24072622]
[16]
Joshi MD, O’Kelly CJ, Krings T, Fiorella D, Marotta TR. Observer variability of an angiographic grading scale used for the assessment of intracranial aneurysms treated with flow-diverting stents. AJNR Am J Neuroradiol 2013; 34(8): 1589-92.
[http://dx.doi.org/10.3174/ajnr.A3431] [PMID: 23449648]
[17]
Kan P, Srinivasan VM, Mbabuike N, et al. Aneurysms with persistent patency after treatment with the pipeline embolization device. J Neurosurg 2016; 126(6): 1894-8.
[http://dx.doi.org/10.3171/2016.6.JNS16402] [PMID: 27636182]
[18]
Cagnazzo F, Lefevre PH, Mantilla D, et al. Patency of the supraclinoid internal carotid artery branches after flow diversion treatment. A meta-analysis. J Neuroradiol 2019; 46(1): 9-14.
[http://dx.doi.org/10.1016/j.neurad.2018.07.006] [PMID: 30099016]
[19]
Pagiola I, Mihalea C, Caroff J, et al. Flow diversion treatment of aneurysms of the complex region of the anterior communicating artery: Which stent placement strategy should ‘I’ use? A single center experience. J Neurointerv Surg 2019; 11(11): 1118-22.
[http://dx.doi.org/10.1136/neurintsurg-2019-014858] [PMID: 30975737]
[20]
Porto GBF, Al Kasab S, Sattur MG, et al. Endovascular management of distal anterior cerebral artery aneurysms: A multicenter retrospective review. World Neurosurg 2021; 154: e421-7.
[http://dx.doi.org/10.1016/j.wneu.2021.07.055] [PMID: 34284157]
[21]
Park HS, Kwon SC, Kim M, Park ES, Sim HB, Lyo IU. Endovascular coil embolization of distal anterior cerebral artery aneurysms: Angiographic and clinical follow-up results. Neurointervention 2013; 8(2): 87-91.
[http://dx.doi.org/10.5469/neuroint.2013.8.2.87] [PMID: 24024072]
[22]
Sattur MG, Li Y, Almallouhi E, Lena J, Spiotta AM. Lessons learned from endovascular coil embolization of pericallosal artery aneurysms and adoption of flow diversion: A retrospective cohort assessment of the efficacy of coiling and flow diversion. World Neurosurg 2019; 129: e444-51.
[http://dx.doi.org/10.1016/j.wneu.2019.05.181] [PMID: 31150866]
[23]
Dabus G, Grossberg JA, Cawley CM, et al. Treatment of complex anterior cerebral artery aneurysms with Pipeline flow diversion: Mid-term results. J Neurointerv Surg 2017; 9(2): 147-51.
[http://dx.doi.org/10.1136/neurintsurg-2016-012519] [PMID: 27382125]
[24]
Tang Q, Feng Y, Zhang C, Zhang T, Zhao W. A comparison of atlas and leo baby stents-assisted coiling of intracranial aneurysms with small parent vessels. Ann Med Surg 2023; 85(8): 3783-90.
[http://dx.doi.org/10.1097/MS9.0000000000000938] [PMID: 37554899]
[25]
Cagnazzo F, Perrini P, Dargazanli C, et al. Treatment of unruptured distal anterior circulation aneurysms with flow-diverter stents: A meta-analysis. AJNR Am J Neuroradiol 2019; 40(4): 687-93.
[http://dx.doi.org/10.3174/ajnr.A6002] [PMID: 30872418]
[26]
Schuette AJ, Hui FK, Spiotta AM, et al. Endovascular therapy of very small aneurysms of the anterior communicating artery: five-fold increased incidence of rupture. Neurosurgery 2011; 68(3): 731-7.
[http://dx.doi.org/10.1227/NEU.0b013e3182077373] [PMID: 21164380]
[27]
Sedat J, Chau Y, Gaudart J, Sachet M, Beuil S, Lonjon M. Stent-assisted coiling of intracranial aneurysms using LEO stents: long-term follow-up in 153 patients. Neuroradiology 2018; 60(2): 211-9.
[http://dx.doi.org/10.1007/s00234-017-1965-1] [PMID: 29273960]
[28]
Duan Y, Qin X, An Q, Liu Y, Li J, Chen G. A new classification of anterior choroidal artery aneurysms and its clinical application. Front Aging Neurosci 2021; 13596829
[http://dx.doi.org/10.3389/fnagi.2021.596829] [PMID: 33790777]
[29]
Ni H, Zhao LB, Liu S, Jia ZY, Cao YZ, Shi HB. The safety and efficacy of endovascular treatment for very small ruptured anterior communicating artery aneurysms: A large single-center experience with 81 consecutive cases. World Neurosurg 2021; 152: e576-82.
[http://dx.doi.org/10.1016/j.wneu.2021.06.025] [PMID: 34133994]
[30]
Lu J, Liu J, Wang L, Qi P, Wang D. Tiny intracranial aneurysms: Endovascular treatment by coil embolisation or sole stent deployment. Eur J Radiol 2012; 81(6): 1276-81.
[http://dx.doi.org/10.1016/j.ejrad.2011.03.005] [PMID: 21435809]
[31]
Huang QH, Wu YF, Xu Y, Hong B, Zhang L, Liu JM. Vascular geometry change because of endovascular stent placement for anterior communicating artery aneurysms. AJNR Am J Neuroradiol 2011; 32(9): 1721-5.
[http://dx.doi.org/10.3174/ajnr.A2597] [PMID: 21816920]
[32]
Suleyman K, Korkmazer B, Kocer N, Islak C. Kızılkılıc O. Evaluation of short- and long-term results of Y-stent-assisted coiling with Leo stents in endovascular treatment of wide-necked intracranial bifurcation aneurysms. Neuroradiology 2023; 65(4): 785-91.
[http://dx.doi.org/10.1007/s00234-023-03116-x] [PMID: 36651939]
[33]
Phuyal S, Lamichhane S, Mishra B, Nayak MK. “Shelf technique” in braided stent (Leo Baby) in wide-necked intracranial aneurysm. J Neurosci Rural Pract 2023; 14(3): 528-30.
[http://dx.doi.org/10.25259/JNRP_23_2023] [PMID: 37692819]

Rights & Permissions Print Cite
Article Metrics
22
3
Wayfinder Image
Open Access Journals Promotions
© 2024 Bentham Science Publishers | Privacy Policy