Atlas self-expandable stents versus low profile visualized intraluminal support stents for intracranial aneurysm coiling assistance: systematic review and meta-analysis.

Abstract

Background: Neurointerventionalists performing stent assisted coil embolization for intracranial aneurysms use Neuroform Atlas stents (Stryker) for their low metal coverage, deployment ease, and lower thromboembolic risk, although low profile visualized intraluminal support (LVIS) and LVIS Jr stents (Terumo Neuro) offer better wall apposition and high metal coverage, potentially promoting flow diversion and endothelialization. The next generation LVIS Evolution (LVIS EVO; Terumo Neuro) adds enhanced visibility, improved resheathability, and even higher metal coverage to address earlier limitations of LVIS and LVIS Jr. We evaluated the performance and complications of these devices.

Methods: PubMed and Embase were searched from 1 January 2017 to 31 July 2025 to identify studies comparing Atlas assisted coil embolization (AACE) versus LVIS/LVIS Jr assisted coil embolization (LACE), and single arm LVIS EVO assisted coil embolization (LeACE) studies. Meta-analyses were performed to compare baselines, procedural considerations, and occlusion rates.

Results: We included five studies comparing 504 patients treated with AACE and 579 patients with LACE, and 12 studies evaluating LeACE (575 patients). Fewer aneurysms were ruptured at presentation in the AACE group than in the LACE (OR 0.09; P<0.01) and LeACE (0.7% vs 15.2%; P<0.01) groups. Comparable technical failure rates were found between AACE and LeACE (1.8% vs 5.4%; P=0.15), contrasting with the superiority of AACE over LACE (OR 0.14; P<0.01). AACE resulted in higher immediate adequate occlusion than LACE (OR 1.62; P=0.02), but comparable with LeACE (83% vs 90.8%; P=0.28). Follow-up complete occlusion rates were similar between AACE and LACE (OR 1.31; P=0.16) and between AACE and LeACE (82.4% vs 81.2%; P=0.86).

Conclusions: The superior outcomes of the Atlas over LVIS/LVIS Jr were matched by the LVIS EVO. Thromboembolic complications occurred more frequently with the LVIS EVO.