Preliminary Results of Y-Stent-Assisted Coil Embolization of Wide-Necked Intracranial Aneurysms: 8 Consecutive Patients

Lee, Jun Seok; Choi, Chang Hwa; Lee, Jae Il; Ko, Jun Kyeung; Cha, Seung Heon; Lee, Tae Hong

Abstract

OBJECTIVE
The endovascular treatment of wide-necked intracranial aneurysms is challenging. The stent-assisted coil embolization has facilitated treatment of such complex aneurysms. However, the single stent-assisted technique has a limitation for the wide-necked intracranial aneurysm at the arterial bifurcation. The Y-stent-assisted technique could be an alternative solution for these aneurysms. We present a case series where stent-assisted coil embolization where the Y-configuration stent was used.
METHODS
Between January 2007 to December 2010, 8 wide-necked bifurcation aneurysms in 8 patients were treated with the Y-stent technique. Among the eight patients, there were six unruptured aneurysms and the remaining two patients presented with subarachnoid hemorrhage (SAH). Three out of eight aneurysms were located at the anterior communicating artery (ACOM), three at the top of the basilar artery (BA), one at the middle cerebral artery (MCA) bifurcation and one at the pericallosal artery. The size of aneurysm ranged from 3.6 mm to 28.2 mm (mean 8.7 mm, neck size from 3 to 7 mm). Four patients were female and aged ranged from 52 to 73 years.
RESULTS
The Y-stent-assisted coil embolization was successfully performed in all 8 cases. The immediate angiographic results were complete occlusion in 7 cases with a remnant neck the remaining case. Angiographic follow-up was done in six patients and stable occlusion was confirmed in all aneurysms. Acute thromboembolism (TE) during the procedure occurred in 4 patients. There were one acute cerebral infarction due to distal coil migration and one delayed cerebral infarction due to in-stent thrombosis after 2 months.
CONCLUSION
Traditionally microsurgery has been the treatment of choice for wide-necked intracranial aneurysms at the arterial bifurcation. However, with the advancement of new techniques and instruments for endovascular treatment, the Y-stent-assisted coil embolization seems to be a feasible treatment option for reconstruction of these complex aneurysms.