Endovascular Treatment of Ruptured and Unruptured Wide-Neck Intracranial Aneurysms Using LVIS EVO Stent-Assisted Coiling: Mid-Term Results.

Background

Stent-assisted coiling (SAC) is an established treatment for wide-neck intracranial aneurysms. The LVIS EVO stent is a new-generation braided device with improved navigability and radiopacity. We evaluated the safety, feasibility, and mid-term outcomes of LVIS EVO SAC in ruptured and unruptured aneurysms.

Methods

We retrospectively analyzed 242 consecutive patients treated and evaluated from 2020 to 2025; 63 (26.0%) presented with ruptured and 179 (74.0%) with unruptured aneurysms. Aneurysm occlusion was graded by the Raymond-Roy occlusion classification (RROC) on immediate DSA and at 12-18 months using 3T MR angiography. Clinical outcomes were assessed with the modified Rankin Scale (mRS).

Results

Stent delivery succeeded in all cases. Adjunctive angioplasty was required in three procedures. Thromboembolic events occurred in six patients, including four in-stent thromboses treated with eptyfibatide, procedure-related SAH in three, and femoral hematomas in five. Mid-term imaging was available in 228 patients (51 SAH, 177 non-SAH). Adequate occlusion (RROC I-II) was achieved in 48/51 SAH (94.1%) and 169/177 non-SAH (95.5%). Residual sac filling (RROC III) occurred in 11/228 (4.8%), and all retreated. Favorable outcome (mRS 0-2) was observed in 49/63 SAH (77.8%) and 170/179 non-SAH (95.0%). Mortality was 12/63 (19.0%) in SAH-attributed to initial hemorrhage severity-and 2/179 (1.1%) in non-SAH (Takotsubo syndrome, leukemia).

Conclusions

LVIS EVO SAC is a safe and effective option for ruptured and unruptured wide-neck aneurysms, yielding high rates of durable occlusion and favorable functional outcomes. Mid-term data support its reliability as an alternative to other endovascular strategies.