Abstract
BackgroundFlow diversion for intracranial aneurysms is indicated for wide-necked aneurysms in non-perforator-rich segments. However, devices are challenging to deploy in distal/tortuous vasculature. LVIS(TM) EVO(TM) is a braided intermediate-density stent offering greater flexibility and navigability than flow diverters with higher metal-to-surface ratios. We investigated its off-label use as an independent flow diverter for small, complex intracranial aneurysms.MethodsWe retrospectively reviewed patients at a single center who underwent independent stenting with LVIS(TM) EVO(TM) from December 2023 to September 2024. Demographics, procedural details, and angiographic outcomes were analyzed. Follow-up computed tomography angiography was performed from May 2024 to October 2025. Descriptive statistics were used; non-parametric tests compared aneurysm and parent vessel diameters.ResultsNine patients (median age 59; 89% female) with off-label intracranial aneurysms (median diameter 5 mm) were treated using LVIS(TM) EVO(TM) (median diameter 3 mm, length 18 mm). Deployment was technically successful in 100% of cases with no peri-procedural complications. One patient experienced delayed hemorrhage with full neurological recovery. At follow-up (available for 6 patients), 83.3% showed complete aneurysm occlusion (Raymond-Roy Occlusion Classification [RROC] class I). All patients demonstrated 100% stent patency and no new neurological deficits.ConclusionLVIS(TM) EVO(TM) demonstrated technical feasibility and acceptable initial safety as an off-label flow-diverting device for small (as low as 2.5 mm), distal aneurysms in this limited single-center experience. Its favorable deliverability, safety profile, and occlusion rates suggest it as a possible alternative to currently marketed flow diverters in anatomically challenging patients. These findings warrant validation in larger, multicenter studies with extended follow-up.