Safety and hemodynamic efficacy of the LVIS stent in the endovascular treatment of intracranial wide-necked aneurysms: a single-center retrospective study.

backgroundTreating wide-necked aneurysms endovascularly is still difficult. Because of its high metal coverage and flow-diverting capabilities, the LVIS stent may lead to better results. We carried out this retrospective analysis to assess its hemodynamic impact, short-term efficacy, and procedural safety.

methodsAn observational, exploratory retrospective study was conducted between January and December 2023 on 61 consecutive patients with intracranial wide-necked aneurysms receiving LVIS stent-assisted coiling. The group consisted of 35 patients with ruptured aneurysms and 26 people with unruptured aneurysms. The Raymond-Roy Occlusion Classification (RROC) was used to assess the initial angiographic data. At 3 to 6 months, clinical outcomes were evaluated using the modified Rankin Scale (mRS), and parent artery patency and aneurysm recurrence were evaluated using follow-up digital subtraction angiography (DSA). Furthermore, a subset of patients underwent computational fluid dynamics (CFD) analysis to measure changes in intra-aneurysmal mean flow velocity and wall shear stress (WSS) in order to quantify hemodynamic modifications.

resultsThis study included 35 patients with ruptured and 26 with unruptured aneurysms, with 61 patients totally. Immediate complete occlusion (RROC class I) was achieved in 80.0% (28/35) of ruptured and 84.6% (22/26) of unruptured aneurysms. Angiographic follow-up (available for 27 patients, 44.3%) at 6-12 months demonstrated stable occlusion in all initial RROC-I cases. Furthermore, in the ruptured cohort, the rate of favorable outcome (mRS 0-1) increased from 57.1% at discharge to 77.1% at follow-up, while 96.2% of unruptured patients maintained an mRS of 0-1. Procedure-related complications involved intraprocedural thrombosis (2 ruptured cases) and one fatal in-hospital stent thrombosis (unruptured case), resulting in overall morbidity and mortality rates of 16.4% and 1.6%, respectively. CFD analysis demonstrated significant and durable hemodynamic improvements. Specifically, post-operative reductions in relative inflow, aneurysm volume with high flow, and WSS were all sustained at 6-month follow-up (all P < 0.001).

conclusionsOur study provides preliminary evidence that LVIS stent-assisted coiling may be related to high aneurysm occlusion rate, functional recovery in ruptured cases, and favorable hemodynamic modification. However, this study fails to achieve causal inference due to the retrospective design, and the complication profile underscores procedural risks, highlighting the need for prospective, comparative studies to confirm its safety and efficacy profile.