LVIS EVO支架治疗宽颈颅内动脉瘤的高分辨率Micro-DynaCT评估与中期临床结局：美国单中心大样本安全性与有效性经验
该单中心回顾性研究纳入53例LVIS EVO支架治疗的宽颈颅内动脉瘤患者，采用Micro-DynaCT评估支架贴壁与金属覆盖率，中期随访显示35/38例（92.1%）达到充分闭塞（RROC 1-2级），围术期血栓并发症3例（5.6%）均经动脉内替罗非班处理无永久性神经功能缺损，无迟发并发症。
要点
- Micro-DynaCT可清晰显示LVIS EVO支架贴壁与瘤颈金属覆盖率，提供术中反馈。
- 中期随访RROC 1-2级充分闭塞率达92.1%（35/38例）。
- 围术期血栓并发症5.6%，经动脉内替罗非班处理均无永久性神经功能缺损。
核心结论
- LVIS EVO支架在三种部署策略下治疗颅内动脉瘤均显示良好的安全性和有效性，中期随访闭塞率高、并发症少。
- Micro-DynaCT在所有病例中实现支架完全可视，可靠记录支架行为、瘤颈金属覆盖率和壁贴壁情况，提供其他支架平台无法实现的术中反馈。
研究设计与样本
- 回顾性单中心连续队列研究，纳入2024年1月至2025年2月53例接受LVIS EVO支架治疗的颅内动脉瘤患者。
- 超过90%病例由单一术者完成，主要采用桡动脉入路。
- 支架部署策略包括：弹簧圈辅助（ jailed微导管技术）、WEB瘤内装置联合、或单纯血流导向。
- 所有病例使用Micro-DynaCT评估支架贴壁和瘤颈金属覆盖率；即刻和3-6个月随访采用导管造影评估闭塞状态和并发症。
关键影像表现/征象
- Micro-DynaCT显示2例患者存在支架不完全贴壁。
- 随访造影显示35/38例（92.1%）达到充分闭塞（RROC 1-2级）。
- 围术期血栓并发症3例（5.6%），均经动脉内替罗非班处理后无永久性神经功能缺损。
- 中期随访无迟发并发症。
诊断标准与关键数值
- 动脉瘤闭塞采用RROC分级评估，充分闭塞定义为Grade 1-2 RROC，随访38例中35例（92.1%）达到。
- 支架贴壁和瘤颈金属覆盖率通过Micro-DynaCT评估，2例发现不完全贴壁。
临床应用与阅片要点
- Micro-DynaCT可用于术中验证LVIS EVO支架的贴壁和瘤颈金属覆盖，辅助判断支架部署效果。
- 对于宽颈颅内动脉瘤，LVIS EVO可结合弹簧圈、WEB或单独血流导向策略使用。
- 围术期血栓并发症可通过动脉内替罗非班处理，需注意监测。
局限性
- 回顾性单中心设计，样本量53例，随访仅38例 available，中期随访时间3-6个月。
- 超过90%病例由单一术者完成，结果可能受术者经验影响。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND AND PURPOSE: The Low-profile Visualized Intraluminal Support EVO (LVIS EVO) is a next-generation braided stent designed for wide-neck intracranial aneurysm treatment. It offers complete fluoroscopic visibility, enhanced flow diversion-like effects, high metal coverage, and compatibility with 0.017-inch microcatheters for distal access. This study evaluated real-world safety and efficacy of LVIS EVO in a large, consecutive single-center cohort with high-resolution micro-DynaCT assessment and mid-term follow-up.
MATERIALS AND METHODS: We retrospectively reviewed 53 consecutive patients treated with LVIS EVO between January 2024 and February 2025. Over 90% of cases were performed by a single surgeon using predominantly radial arterial access. The device was deployed across three strategies: with coils (jailed microcatheter technique), with WEB intrasaccular devices, or as standalone flow diversion. Patient demographics, aneurysm characteristics, and procedural details were recorded. Stent apposition and metal coverage at the neck were assessed in all cases using micro-DynaCT. Occlusion status and complications were assessed immediately and at 3- to 6-month follow-up using catheter-based angiography.
RESULTS: Median patient age was 69 years (IQR, 61-75), with 41 patients (77.4%) being female. Aneurysms were most often located in the anterior communicating artery (20, 37.7%), basilar artery (16, 30.2%), and middle cerebral artery bifurcation (8, 15.1%). Periprocedural thrombotic complications occurred in 3 patients (5.6%), all successfully managed with intra-arterial tirofiban without permanent neurological deficits. No delayed complications occurred at mid-term follow-up. Among 38 patients with available follow-up, 35 achieved adequate occlusion (Grade 1-2 RROC: 92.1%), with incomplete stent apposition noted on micro-DynaCT in 2 patients.
CONCLUSION: LVIS EVO demonstrated favorable safety and efficacy for treating intracranial aneurysms across three deployment strategies, with minimal complications and high occlusion rates at mid-term follow-up. Complete micro-DynaCT visibility in all cases enabled reliable documentation of stent behavior, metal coverage at the neck, and wall apposition, providing intraprocedural feedback not achievable with other stent platforms.
引用
- Almasri S, Kim J, Gandhi OH, et al. High-Resolution Micro-DynaCT Assessment and Mid-Term Clinical Outcomes of the LVIS EVO Stent for Wide-Neck Intracranial Aneurysms: Safety and Efficacy from a Large U.S. Single-Center Experience. AJNR Am J Neuroradiol. 2026. PMID: 42209149. doi:10.3174/ajnr.A9433
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。