The Source for Neurovascular News and Education

August 23, 2019

 

The lead investigator says the difference in obliteration rates came as a surprise.

 

Use of the Atlas stent for coiling of intracranial aneurysms is associated with a greater obliteration rate and less in-stent restenosis compared with the LVIS Jr, according to a single-center database analysis published August 4, 2018 in the Journal of NeuroInterventional Surgery.

 

In an interview with Neurovascular Exchange, lead author Bradley Gross, MD (University of Pittsburgh Medical Center, Pittsburgh, PA), explained that, in the United States, the Atlas (Stryker Neurovascular) and the LVIS Jr (Microvention Terumo) are the primary stents being used to treat intracranial aneurysms. Certain features of each make them a more or less popular choice for individual operators, including the fact that the LVIS Jr is retrievable and more visible than the Atlas, while the Atlas can be easier to deploy and cross lesions.

 

Most of the available data on the use of individual stents for aneurysm coiling are single arm, he continued, so more comparative data are needed. He and his colleagues had the clinical impression that in-stent restenosis rates were greater with the LVIS Jr than the Atlas, so they decided to compare data and find out.

 

Gross and colleagues used their institutional endovascular database to identify 64 patients who underwent aneurysm coiling (37 with Atlas stent placement and 27 with LVIS Jr). The two groups of patients were similar with regard to aneurysm location, size, coiling technique, and coil packing density.

 

A comparison of outcomes revealed that the rate of initial Raymond 1 occlusion was significantly greater in the Atlas cohort. Follow-up digital subtraction angiography (DSA) revealed greater rates of Raymond 1 and 2 occlusion with Atlas stenting, as well as a lower rate of in-stent restenosis, compared with LVIS Jr stenting. Rates of clinical postoperative ischemic complications were similar between groups.

 

Outcomes of Aneurysm Coiling Using Atlas vs LVIS Jr Stents

 

Atlas

(n = 37)

LVIS Jr

(n = 27)

P Value

Initial Raymond 1 Occlusion

57%

41%

0.03

Raymond 1 or 2 Occlusion on DSA Follow-Up

100%

81%

0.04

Symptomatic Ischemic Postoperative Complication

3%

15%

0.15

In-Stent Restenosis

0

19%

0.04

 

Posttreatment MRI diffusion-weighted imaging was performed in 23 patients who underwent Atlas stent placement and 21 patients who underwent LVIS Jr stent placement. In this subgroup of patients, there were no significant differences in rates of diffusion restriction, single punctate area, or multiple areas.

 

Obliteration Rate Differences a Surprise

 

The findings regarding in-stent restenosis came as no surprise to Gross, since this matched his and his colleagues’ clinical perceptions. He said he had not expected to find, though, that obliteration rates were also better with the Atlas stent.

 

However, the study is too small and limited to draw firm conclusions. “I definitely think it needs to be highlighted that this is a small, single-center study,” said Gross. “It really should be validated in larger multicenter, multiuser studies. . . . Nevertheless, no matter how much bias there is, if we have a study where we have 37 Atlas stents, and there are no cases of restenosis and 27 LVIS Jr stents, and there are four, that’s a lot of signal that I suspect would carry through.”

 

 


Source:

Gross BA, Ares WJ, Ducruet AF, et al. A clinical comparison of Atlas and LVIS Jr stent-assisted aneurysm coiling. J NeuroIntervent Surg. 2018;Epub ahead of print.

 

Disclosures:

Gross reports consulting for Microvention.