Safety and Hemodynamic Efficacy of the LVIS Stent in the Endovascular Treatment of Intracranial Wide-Necked Aneurysms: A Single-Center Retrospective Study

Objective: To evaluate the procedural safety, short-term efficacy, and hemodynamic impact of the low-profile visualized intraluminal support (LVIS) stent in treating intracranial wide-necked aneurysms. Methods: A retrospective analysis was conducted on 61 consecutive patients with intracranial wide-necked aneurysms undergoing LVIS stent-assisted coiling between January and December 2022. The cohort comprised 35 patients with ruptured aneurysms and 26 with unruptured aneurysms. The Raymond-Roy Occlusion Classification (RROC) was employed to assess the immediate angiographic results. Clinical outcomes were evaluated at 3-6 months using the modified Rankin Scale (mRS), with parent artery patency and aneurysm recurrence evaluated using follow-up digital subtraction angiography (DSA). Additionally, computational fluid dynamics (CFD) analysis was adopted in a subset of patients to quantify hemodynamic alterations by measuring changes in wall shear stress (WSS) and intra-aneurysmal mean flow velocity. Results: Embolization Efficacy: Immediate postprocedural angiography revealed RROCclass I in 28 (80.0%) and class II in 7 (20.0%) ruptured aneurysms; as well as class I in 22 (84.6%) and class II in 4 (15.4%) unruptured aneurysms. Complications and Outcomes: Intraprocedural thrombosis occurred in 2 patients with ruptured aneurysms; patency was restored following intra-arterial tirofiban administration, though one patient sustained residual neurological deficits. The results of mRS at 3–6 months in the ruptured group showed 0 (n=21), 1 (n=6), 2 (n=3), 3 (n=2), and 5 (n=3). In the unruptured group, one case exhibited suboptimal stent expansion. One patient developed postoperative neurological deterioration and died after discontinuing dual antiplatelet therapy, without stent thrombosis or parent vessel occlusion via subsequent angiography. Imaging Follow-up: Fourteen patients with ruptured and 13 with unruptured aneurysms were followed up by DSA at 6 months. It was observed with patent parent arteries without stenosis, thrombosis, or aneurysm recurrence. Hemodynamic Analysis: CFD analysis indicated a significant immediate reduction in intra-aneurysmal WSS postoperatively (P<0.001), which remained significant at 6 months (P<0.001). In addition, there was significantly decreased intra-aneurysmal flow velocity (P=0.021), albeit with substantial interindividual variability. Conclusion: LVIS stent-assisted coiling demonstrates a favorable safety profile, technical feasibility, and reliable short-term efficacy for treating intracranial wide-necked aneurysms, including those in the acute rupture phase, with concurrent improvement in intra-aneurysmal hemodynamic environment.