User Tools

Site Tools


lvis_jr

Table of Contents

LVIS Jr

Intraluminal device from Microvention.

The lowest profile delivery system in coil embolization intraluminal support • 3 Flared Ends • Single Nitinol Wire Braid • Larger Compliant Cell System - Compliant 1.5mm cell size is 50% larger than standard LVIS device, and complements today's softer, smaller embolization coils • 3 Radiopaque Strands and 3 Distal / Proximal Markers

The LVIS® Jr. device may be tracked and deployed through a .017“ (0.43mm) inner diameter Headway®17 Advanced microcatheter or Scepter occlusion balloon catheter

*LVIS® Jr. has received HDE Approval

RX Only. Humanitarian Device: Authorized by Federal Law for use with bare platinum embolic coils for the treatment of unruptured, wide neck (neck ≥ 4 mm or dome to neck ratio < 2), intracranial, saccular aneurysms arising from a parent vessel with a diameter ≥ 2.5 mm and ≤ 4.5 mm. The effectiveness of this device for this use has not been demonstrated.


Wide necked bifurcation intracranial aneurysms have traditionally not been amenable to coil embolization with the use of a single stent due to the high risk of coil prolapse.

The treatment of wide-neck bifurcation cerebral aneurysms is challenging especially if at least one of the arteries arise from an obtuse angle. These wide-neck bifurcation aneurysms are difficult to treat with the usual balloon and stent assisted coiling, including Y stenting or double-barrel stent techniques.

Other available options include using current devices with the waffle cone or double waffle cone techniques.

Novel devices that are in development include intrasaccular devices and the barrel bifurcation vascular reconstruction device (Covidien).


Y-configuration double stent-assisted coil embolization ('Y-stenting') of this aneurysm type has been shown to have generally good clinical outcomes, although the technique is complex with various challenges described in the literature. The compliant and flexible closed-cell design of braided stents such as the LVIS Jr allows for the creation of a 'shelf' across the aneurysm neck sufficient to prevent coil prolapse. We describe this novel 'shelf' technique and present a small case series of LVIS Jr stent-assisted wide-necked bifurcation intracranial aneurysm coiling in eight patients. Our small, albeit important, case series demonstrates that the 'shelf' technique is feasible and safe with very good short-term clinical and angiographic outcomes, and may obviate the need for Y-stenting 1).

Case series

LVIS Jr case series

Case reports

Intracranial pseudoaneurysm is a rare complication of endoscopic endonasal surgery. Herein, Morinaga et al., describe two-staged stent assisted coil embolization for posterior communicating artery pseudoaneurysm after endoscopic endonasal surgery for pituitary adenoma.

A 68-year-old man had a history of severe adult growth hormone secretion deficiency, requiring growth hormone replacement therapy; secondary adrenal hypofunction; hyperthyroidism; hypertension; constipation; glaucoma; and hyperuricemia. Five years ago, after initial endoscopic transsphenoidal surgery for pituitary adenoma, he was hospitalized for reoperation. Posterior communicating artery injury was observed during second endoscopic trans-sphenoidal surgery and pressure hemostasis was performed using a hemostatic preparation. Immediately post-surgery, a localized subarachnoid hemorrhage was observed. Sudden-onset impaired consciousness and respiratory disturbances ensued on postoperative day 7, and computed tomography of the head was performed. Recurrent subarachnoid hemorrhage was confirmed, and acute hydrocephalus secondary to third ventricular blockage was identified. Cerebral angiography was performed after urgent bilateral cerebral ventricular drainage under general anesthesia. A pseudoaneurysm was identified in the left posterior communicating artery, and coil embolization was performed. Six weeks post-surgery, LVIS® Jr. stent was placed in the posterior communicating artery. Recurrence of the aneurysm was not detected 6 months post-surgery. He underwent lumboperitoneal shunting for secondary normal pressure hydrocephalus after dual antiplatelet therapy discontinuation and is being followed-up as an outpatient with a modified Rankin Scale of 2 10 months post-surgery.

Two-staged stent-assisted coil embolization using LVIS® stent was effective for a posterior communicating artery pseudoaneurysm occurring after posterior communicating artery injury following endoscopic trans-sphenoidal surgery for follicle-stimulating hormone-producing pituitary adenoma 2).

2014

Conrad et al., report the results of the first two cases of wide necked basilar tip aneurysms treated with Y stent assisted coil embolization using a new low profile visible intraluminal stent (LVIS Jr; MicroVention, Tustin, California, USA) delivered through a 0.017 inch microcatheter. They also reviewed the literature comparing other endovascular techniques (coiling alone, stent assisted coiling, and Y stent assisted coiling) for wide necked aneurysms. The LVIS Jr device offers a new option for the treatment of these challenging lesions, with clear advantages over currently available intracranial stents. Larger series and long term results are needed to confirm the applicability and durability of this technique/technology 3)

2013

A 51-year-old patient with an unruptured right middle cerebral artery bifurcation aneurysm was treated with balloon remodeling employing a 4 × 10 mm Scepter C balloon catheter. Following coil embolization, a low-profile visualized intraluminal stent (LVIS) Jr 2.5 mm × 16 mm was delivered via the coaxial balloon catheter and deployed across the aneurysm neck.

Follow-up angiograms demonstrated that the coil mass was well-seated within the aneurysm sac and the parent vessel was widely patent with satisfactory vessel wall apposition by the stent.

Spiotta et al., describe a technique for balloon remodeling followed by stenting for aneurysm coil embolization that incorporates the use of a coaxial dual-lumen balloon catheter system through which a novel self-expanding stent can be deployed. In the case described, we found this technique to be safe and feasible, reducing both the number of steps involved in this technique and the opportunities for mechanical coil-related complications 4).

1)
Du EH, Shankar JJ. LVIS Jr 'shelf' technique: an alternative to Y stent-assisted aneurysm coiling. J Neurointerv Surg. 2016 Feb 4. pii: neurintsurg-2015-012246. doi: 10.1136/neurintsurg-2015-012246. [Epub ahead of print] PubMed PMID: 26847331.
2)
Morinaga Y, Nii K, Sakamoto K, Inoue R, Mitsutake T, Hanada H. Stent-assisted Coil Embolization for a Ruptured Posterior Communicating Artery Pseudoaneurysm after Endoscopic Trans-sphenoidal Surgery for Pituitary Adenoma. World Neurosurg. 2018 Dec 21. pii: S1878-8750(18)32870-5. doi: 10.1016/j.wneu.2018.12.047. [Epub ahead of print] PubMed PMID: 30583130.
3)
Conrad MD, Brasiliense LB, Richie AN, Hanel RA. Y stenting assisted coiling using a new low profile visible intraluminal support device for wide necked basilar tip aneurysms: a technical report. J Neurointerv Surg. 2014 May;6(4):296-300. doi: 10.1136/neurintsurg-2013-010818. Epub 2013 Jun 22. PubMed PMID: 23794675.
4)
Spiotta AM, Miranpuri A, Chaudry MI, Turner RD 4th, Turk AS. Combined balloon stent technique with the Scepter C balloon and low-profile visualized intraluminal stent for the treatment of intracranial aneurysms. J Neurointerv Surg. 2013 Nov;5 Suppl 3:iii79-iii82. doi: 10.1136/neurintsurg-2012-010553. Epub 2012 Nov 20. PubMed PMID: 23172541.
lvis_jr.txt · Last modified: 2019/11/23 14:13 by administrador