Utility of bulging technique for endovascular treatment of small and wide-necked aneurysms with a Low-profile Visualized Intraluminal Support (LVIS Jr.) device: A case report and review of the literature

作者：Inoue Akihiro; Tagawa Masahiko; Matsumoto Shirabe; Nishikawa Masahiro; Kusakabe Kosuke; Watanabe Hideaki; Kunieda Takeharu

来源：Interventional Neuroradiology, 2018, 24(2): 125-129.

DOI：10.1177/1591019917743065

• Bulging technique
• cone-beam CT
• LVIS Jr.
• small and wide-necked aneurysm

Small and broad-necked aneurysms are generally very difficult to treat using endovascular therapy. The arrival of the low-profile stent (e.g., Low-profile Visualized Intraluminal Support; LVIS) has enabled reconstructive treatment for these aneurysms. In addition, the bulging technique using LVIS is an effective and attractive technique for performing stent-assisted coiling to preserve parent arteries and achieve neck coverage. We report here a patient with a small and wide-necked ruptured basilar artery (BA) top aneurysm, in whom successful treatment was achieved by stent-assisted coiling with LVIS Jr. using the bulging technique. A 74-year-old woman with moderate hypertension consulted for treatment of subarachnoid hemorrhage with a ruptured BA top aneurysm measuring 2.7mm in height with a 4.3mm neck. We initially tried emergency balloon-assisted coiling, but coiling proved difficult. We therefore performed stent-assisted coiling with LVIS Jr. using the bulging technique. The postoperative course was uneventful, with no aggravation of neurological symptoms, and the patient was discharged 14 days postoperatively. This treatment strategy with LVIS Jr. using the bulging technique may be very useful for patients with a ruptured aneurysm with a small and broad neck that would otherwise require treatment with intravascular devices or open surgery.