Flow Diversion via LVIS Blue Stent within Enterprise Stent in Patients with Vertebral Artery Dissecting Aneurysm

A new Low-profile Visualized Intraluminal Support device (LVIS Blue) is a braided stent that provides a higher degree of metal coverage. This stent may be beneficial for complete obliteration of an aneurysm due to not only its support of a higher occlusion rate using coils inside of the aneurysm but also its flow-diverting effect. We introduce and describe a new flow-diversion technique using an LVIS Blue stent within an Enterprise stent for patients with vertebral artery (VA) dissecting aneurysms. A 6-Fr guiding catheter was positioned in the ipsilateral VA. A microcatheter with an inner diameter of 0.021 inches was navigated and positioned across the dissecting segment of the VA. An Enterprise stent was then deployed and used to cover the dissecting segment by pushing the pusher wire of the stent while simultaneously unsheathing the microcatheter. The microcatheter was navigated along the remaining pusher wire to the distal VA through the Enterprise stent. An LVIS Blue stent was introduced and positioned such that it overlapped the previous stent in order to divert blood flow away from the dissecting segment. We present a case in which this technique was used to successfully obliterate a dissecting aneurysm while maintaining the VA patency with vessel wall remodeling. The LVIS Blue stent-within-an-Enterprise stent technique may be an effective treatment option for patients with VA dissecting aneurysms as an alternative technique to flow diverters.