Deployment techniques and crossability of the EVO stent in wide-neck bifurcation aneurysms: An in vitro evaluation

Background Stent-assisted coiling (SAC) is a well-established technique for treating wide-neck and bifurcation intracranial aneurysms. The second-generation Low-Profile Visualized Intraluminal Support (LVIS) EVO stent offers improved fluoroscopic visibility and deployment control; however, bench data on its performance in complex configurations remains limited. Objective To evaluate the deployment and crossability of the LVIS EVO stent using shouldering and Y-stenting (crossing and parallel) techniques in a flow model, given their complexity and clinical relevance in the treatment of wide-neck bifurcation aneurysms. Methods Two silicone basilar tip aneurysm replicas were used in a flow model under physiological conditions. LVIS EVO stents were deployed using the three techniques. A 0.014-inch microwire and 0.017-inch microcatheter were used to assess crossability through inner and outer vessel curvatures. Outcomes included device tracking under fluoroscopy, deployment success, and crossability profile. Results All stent deployments were technically successful with accurate positioning, excellent fluoroscopic visibility, and no evidence of migration, prolapse, or deformation. Crossability testing confirmed that a 0.017-inch microcatheter and 0.014-inch microwire could be advanced smoothly through both the stent lumen and across the stent walls in all configurations without the need for additional maneuvers. Conclusion The LVIS EVO stent demonstrated reliable deployment and crossability across complex bifurcation configurations in a flow model. Its radiopacity and flexible design support its use in advanced SAC techniques.