Multiple Overlapping Low-Profile Visualized Intraluminal Support Stents for Large Extracranial Carotid Artery Aneurysms: A Case Series

Extracranial carotid artery aneurysms (ECAAs) are rare, and the optimal therapeutic modality for these lesions remains controversial. Surgical resection and covered stents may be limited to selected cases. While the concept of using flow diversion is appealing for large aneurysms, the application of flow diverters in extracranial carotid lesions may face restrictions due to off-label use, reimbursement challenges, and factors related to the devices themselves. We report our experience with multiple overlapping Low-profile Visualized Intraluminal Support (LVIS) stents as a reconstructive option for selected ECAAs. Five patients with large ECAAs were treated with multiple overlapping LVIS stents. The primary goal was parent-artery reconstruction and reduction of intra-aneurysmal flow reduction by increasing local metal coverage across the neck of the aneurysm. Double overlapping LVIS stents were used in 3 cases, whereas triple or more extensive overlapping constructs were used in 2 cases. During a mean radiologic follow-up of 24 months, complete occlusion in 2 cases, partial occlusion in 3 cases, and adjunctive procedures in 3 cases were required, and no major thromboembolic or hemorrhagic complications were documented. Adjunctive or staged treatment was required in 3 cases, including balloon angioplasty, additional LVIS stenting, flow-diverter placement, stent-graft placement, or coil embolization. Multiple overlapping LVIS stenting is a feasible and relatively safe reconstructive option for selected large or clinically significant ECAAs, particularly when primary flow-diverter treatment is constrained by off-label indication or reimbursement issues. However, they have limited standalone efficacy, particularly in large or complex aneurysms, often requiring adjunctive or staged treatment.