Endovascular Treatment of Ruptured and Unruptured Wide-Neck Intracranial Aneurysms Using LVIS EVO Stent-Assisted Coiling: Mid-Term Results.

Background: Stent-assisted coiling (SAC) is an established treatment for wide-neck intracranial aneurysms. The LVIS EVO stent is a new-generation braided device with improved navigability and radiopacity. We evaluated the safety, feasibility, and mid-term outcomes of LVIS EVO SAC in ruptured and unruptured aneurysms. Methods: We retrospectively analyzed 242 consecutive patients treated and evaluated from 2020 to 2025; 63 (26.0%) presented with ruptured and 179 (74.0%) with unruptured aneurysms. Aneurysm occlusion was graded by the Raymond-Roy occlusion classification (RROC) on immediate DSA and at 12-18 months using 3T MR angiography. Clinical outcomes were assessed with the modified Rankin Scale (mRS). Results: Stent delivery succeeded in all cases. Adjunctive angioplasty was required in three procedures. Thromboembolic events occurred in six patients, including four in-stent thromboses treated with eptyfibatide, procedure-related SAH in three, and femoral hematomas in five. Mid-term imaging was available in 228 patients (51 SAH, 177 non-SAH). Adequate occlusion (RROC I-II) was achieved in 48/51 SAH (94.1%) and 169/177 non-SAH (95.5%). Residual sac filling (RROC III) occurred in 11/228 (4.8%), and all retreated. Favorable outcome (mRS 0-2) was observed in 49/63 SAH (77.8%) and 170/179 non-SAH (95.0%). Mortality was 12/63 (19.0%) in SAH-attributed to initial hemorrhage severity-and 2/179 (1.1%) in non-SAH (Takotsubo syndrome, leukemia). Conclusions: LVIS EVO SAC is a safe and effective option for ruptured and unruptured wide-neck aneurysms, yielding high rates of durable occlusion and favorable functional outcomes. Mid-term data support its reliability as an alternative to other endovascular strategies.