Treatment of basilar artery aneurysms with two braided stents: Two centers experience of low-profile visualized intraluminal support stents versus Pipeline flow diverters

Abstract

Background Both low-profile visualized intraluminal support (LVIS)stents and Pipeline flow diverters (FDs) are therapeutic strategies for basilar artery (BA) aneurysms, but they have not been directly compared. Methods A total of 132 consecutive patients with 139 BA aneurysms treated with either LVIS stent or Pipeline FDs were analyzed. Propensity score matching (PSM) was used to control for age, sex, hypertension, aneurysm size, shape, location, and duration of follow-up. The treatment results of these two braided stents were compared. Results LVIS stent was placed in 88 (63.3%) and Pipeline FDs in 51 (36.7%) procedures. Patients with Pipeline FDs tended to be younger and have less hypertension, whereas aneurysms had larger aneurysm size. After PSM, similar complete or near-complete occlusion rates (76.7% vs 73.3%, p = .766) and favorable functional outcomes (86.7% vs 90.0%, p = 1) were achieved in patients treated with LVIS stents and Pipeline FDs, respectively. Further comparisons were conducted at three different locations (basilar apex/basilar trunk/vertebrobasilar artery junction [VBJ]) separately, and the results showed a higher complete or near-complete aneurysm occlusion rate after Pipeline FD treatment than LVIS treatment (86.7% vs 59.2%, p = .012) only at VBJ, where a particularly high proportion of non-saccular shape (70.9%) and a male preponderance were noted. Conclusion Both braided stents were effective in the treatment of BA aneurysms, with good occlusion rates and favorable functional outcomes. Pipeline FD achieved a particularly higher aneurysm occlusion rate than LVIS stent at VBJ, where lesions often require reconstruction of the diseased vessel.