LVIS EVO stent-assisted coiling for intracranial aneurysms: results of long-term follow-up

The Low-profile visualized Intraluminal Support EVO (LVIS EVO) is a next-generation braided stent characterized by enhanced visibility and resheathability, and designed for stent-assisted coil embolization of intracranial aneurysms. Despite growing adoption, real-world data on its efficacy and safety remain limited.

This study aims to evaluate the safety and efficacy of the LVIS EVO stent in consecutive patients undergoing treatment for brain aneurysms.

We retrospectively analyzed all patients who underwent treatment of unruptured intracranial aneurysms with the LVIS EVO stent in a single tertiary center between January 2021 and January 2024. Baseline demographics, imaging and procedural characteristics, clinical outcomes, and clinical and radiological follow-up data were collected. The primary endpoints were successful deployment and complete aneurysm occlusion at follow-up as defined by the Raymond-Roy Occlusion Classification. Secondary endpoints included complication rate, modified Rankin Scale (mRS) at last clinical follow-up, and incidence of in-stent stenosis on last follow-up imaging.

Thirty-four patients (64.7% women; median age: 52 years) were treated for 34 saccular aneurysms. Most of the aneurysms were previously ruptured and recanalized after initial treatment (20/34, 58.8%). They were mainly located at the middle cerebral artery (15/34, 44.1%) and the internal carotid artery terminus (8/34, 23.5%), with additional cases at the anterior communicating artery (7/34, 20.6%) and the posterior circulation (4/34, 11.8%). Median aneurysm neck size was 3.3 mm, with an aspect ratio of 1.2 and a dome-to-neck ratio of 1.3. Stent deployment was successful in 100% of cases. Immediate complete occlusion (RROCs I) was achieved in 82.4% of aneurysms. At a median radiological follow-up of 24 months, 91.2% of aneurysms remained completely occluded, and 97.1% were adequately occluded (RROC I-II). Two intraprocedural cases (5.9%) of in-stent thrombosis occurred and were managed successfully. One post-procedural symptomatic ischemic event occurred, but the patient was asymptomatic at the last clinical follow-up. There were no hemorrhagic or permanent ischemic complications. Asymptomatic in-stent stenosis occurred in 2 patients (5.9%). Clinical outcome was favorable (mRS ≤ 2) in 100% of cases at last follow-up.

The LVIS EVO stent demonstrates excellent technical success and sustained aneurysm occlusion with a low complication rate. These results support its safety and efficacy in the treatment of intracranial aneurysms, including previously ruptured lesions and anatomically complex locations.