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Research ArticleNeurointervention

Flow-Diversion Effect of LEO Stents: Aneurysm Occlusion and Flow Remodeling of Covered Side Branches and Perforators

F. Cagnazzo, M. Cappucci, C. Dargazanli, P.-H. Lefevre, G. Gascou, C. Riquelme, R. Morganti, V. Mazzotti, A. Bonafe and V. Costalat
American Journal of Neuroradiology November 2018, 39 (11) 2057-2063; DOI: https://doi.org/10.3174/ajnr.A5803
F. Cagnazzo
aFrom the Neuroradiology Department (F.C., M.C., C.D., P.-H.L., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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M. Cappucci
aFrom the Neuroradiology Department (F.C., M.C., C.D., P.-H.L., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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C. Dargazanli
aFrom the Neuroradiology Department (F.C., M.C., C.D., P.-H.L., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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P.-H. Lefevre
aFrom the Neuroradiology Department (F.C., M.C., C.D., P.-H.L., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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G. Gascou
aFrom the Neuroradiology Department (F.C., M.C., C.D., P.-H.L., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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C. Riquelme
aFrom the Neuroradiology Department (F.C., M.C., C.D., P.-H.L., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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R. Morganti
bSection of Statistics (R.M., V.M.), University Hospital of Pisa, Pisa, Italy.
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V. Mazzotti
bSection of Statistics (R.M., V.M.), University Hospital of Pisa, Pisa, Italy.
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A. Bonafe
aFrom the Neuroradiology Department (F.C., M.C., C.D., P.-H.L., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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V. Costalat
aFrom the Neuroradiology Department (F.C., M.C., C.D., P.-H.L., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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Abstract

BACKGROUND AND PURPOSE: Flow diversion with intermediate-porosity stents (braided stents) has been recently reported for distally located small aneurysms. The aim of this study was to evaluate the flow-diversion effect of LEO stents on covered vessels and for aneurysms treated with sole stent-placement therapy.

MATERIALS AND METHODS: We retrospectively evaluated the following outcomes: 1) remodeling of covered side branches and perforators (extra-aneurysmal flow remodeling), and 2) the occlusion rate of aneurysms treated with sole stent-placement therapy (intra-aneurysmal flow remodeling).

RESULTS: Seventy-six patients with 98 covered vessels were studied. Overall, 89 covered arteries (91%) were normal, 7 showed narrowing (7%), and 2 (2%) were occluded (1 posterior communicating artery and 1 MCA) without related complications (mean DSA follow-up, 14 months). Univariate and multivariate analyses highlighted smoking (P = .03) and the length of follow-up (P = .002) as factors associated with arterial remodeling. Of the 17 Sylvian (lenticulostriate arteries) and 7 basilar perforators, 1 (4%) group of Sylvian perforators covered with double stents had asymptomatic remodeling. Ten aneurysms (mean size, 3.5 mm) were treated with LEO stents as stent monotherapy (5 recanalized after coiling and 5 directly treated with the LEO). Complete occlusion (Raymond-Roy I) was achieved in 70% of aneurysms (mean follow-up, 14 months). The Raymond-Roy I occlusion rate among recanalized aneurysms and those directly treated with LEO stents was 80% and 60%, respectively (P = .9).

CONCLUSIONS: The rate of flow remodeling on the covered arteries and perforators was 9% and 4%, respectively, and was clinically irrelevant in all cases. Complete occlusion of aneurysms treated with sole stent-placement therapy was 70%. These data stress the flow-diversion properties of LEO stents.

ABBREVIATIONS:

PcomA
posterior communicating artery
RR
Raymond-Roy
SAC
stent-assisted coiling
  • © 2018 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 39 (11)
American Journal of Neuroradiology
Vol. 39, Issue 11
1 Nov 2018
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F. Cagnazzo, M. Cappucci, C. Dargazanli, P.-H. Lefevre, G. Gascou, C. Riquelme, R. Morganti, V. Mazzotti, A. Bonafe, V. Costalat
Flow-Diversion Effect of LEO Stents: Aneurysm Occlusion and Flow Remodeling of Covered Side Branches and Perforators
American Journal of Neuroradiology Nov 2018, 39 (11) 2057-2063; DOI: 10.3174/ajnr.A5803

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Flow-Diversion Effect of LEO Stents: Aneurysm Occlusion and Flow Remodeling of Covered Side Branches and Perforators
F. Cagnazzo, M. Cappucci, C. Dargazanli, P.-H. Lefevre, G. Gascou, C. Riquelme, R. Morganti, V. Mazzotti, A. Bonafe, V. Costalat
American Journal of Neuroradiology Nov 2018, 39 (11) 2057-2063; DOI: 10.3174/ajnr.A5803
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