Technical Success and Clinical Outcomes of the Low-Profile Visualized Intraluminal Support EVO (LVIS EVO) Stent in the Treatment of Intracranial Aneurysms: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES: The Low-profile Visualized Intraluminal Support (LVIS) EVO (Terumo Neuro) is the latest development in a series of braided, self-expanding stents designed for intracranial aneurysms and is described as affording enhanced fluoroscopic visibility and improved delivery. Approved in Europe in 2019 and in the United States in 2024, outcomes associated with its use have been reported in few studies. In this meta-analysis, treatment-related complications (safety outcomes), aneurysm occlusion rates (effectiveness outcomes), and technical success rates of the LVIS EVO were evaluated based on the existing literature. METHODS: We conducted a systematic review and meta-analysis of studies identified in PubMed, Ovid MEDLINE, and Embase up to August 19, 2024, reporting on patients with primarily saccular, wide-necked intracranial aneurysms treated with the EVO stent. Data collected included technical success rates, immediate postprocedure and follow-up aneurysm occlusion rates, and treatment-related complications and morbidity. Meta-analysis results were presented as weighted percentages. RESULTS: Seven studies evaluating 422 patients with 435 aneurysms were included. On meta-analysis, the technical success rate was 99.3% (95% CI, 98.5%-100%). Complete occlusion immediately after the procedure and at follow-up were 75.5% (95% CI, 62.1%-89.0%) and 86.8% (95% CI, 80.4%-93.2%), respectively, with a mean follow-up duration of 256 days. The overall treatment-related complication rate was 7.4% (95% CI, 2.6%-12.2%), with a treatment-related morbidity of 1.8% (95% CI, 0.5%-3.0%). The most common complication was ischemic-thromboembolic events, occurring in 4.7% (95% CI, 1.5%-8.0%) of cases, with 2.2% (95% CI, 0.6%-3.8%) being symptomatic. There was no significant difference in the proportion of treatment-related complications between anterior and posterior circulation aneurysms (6.1% vs 9.7%, respectively; P = .441). CONCLUSION: Our results highlight the favorable technical profile of the LVIS EVO device and suggest that the occlusion and treatment-related complication rates are at least comparable with those of its contemporaries.