J Korean Neurosurg Soc.  2012 Sep;52(3):187-192.

Y-Stenting Endovascular Treatment for Ruptured Intracranial Aneurysms : A Single-Institution Experience in Korea

• Lee WJ
• Cho CS

Abstract

OBJECTIVE
Stent-assisted coiling on intracranial aneurysm has been considered as an effective technique and has made the complex aneurysms amenable to coiling. To achieve reconstruction of intracranial vessels with preservation of parent artery the use of stents has the greatest potential for assisted coiling. We report the results of our experiences in ruptured wide-necked intracranial aneurysms using Y-stent coiling.
METHODS
From October 2003 to October 2011, 12 patients (3 men, 9 women; mean age, 62.6) harboring 12 complex ruptured aneurysms (3 middle cerebral artery, 9 basilar tip) were treated by Y-stent coiling by using self-expandable intracranial stents. Procedural complications, clinical outcome, and initial and midterm angiographic results were evaluated. The definition of broad-necked aneurysm is neck diameter over than 4 mm or an aneurysm with a neck diameter smaller than 4 mm in which the dome/neck ratio was less than 2.
RESULTS
In all patients, the aneurysm was successfully occluded with no apparent procedure-related complication. There was no evidence of thromboembolic complication, arterial dissection and spasm during procedure. Follow-up studies showed stable and complete occlusion of the aneurysm in all patients with no neurologic deficits.
CONCLUSION
The present study did show that the Y-stent coiling seemed to facilitate endovascular treatment of ruptured wide-necked intracranial aneurysms. More clinical data with longer follow-up are needed to establish the role of Y-stent coiling in ruptured aneurysms.

Keyword

Intervention; Stent; Subarachnoid hemorrhage

MeSH Terms

Aneurysm
Aneurysm, Ruptured
Arteries
Follow-Up Studies
Humans
Intracranial Aneurysm
Korea
Male
Middle Cerebral Artery
Neck
Parents
Spasm
Stents
Subarachnoid Hemorrhage

Figure

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  Fig. 1 Working view of the left vertebral artery angiogram showing the aneurysm at the basilar tip prior to endovascular intervention.

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  Fig. 2 Immediately post-treatment, working unsubstracted view of the left vertebral artery angiogram showing optimal deployment and no contrast dye filling in aneurysm sac after Y-stenting coiling.

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  Fig. 3 Follow-up angiography was performed 12 months after treatment. Working unsubstracted view of left vertebral artery angiography shows a no interval change after initial treatment.

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  Fig. 4 Three dimensional (3D) cerebral angiography working views shows a middle cerebral artery bifurcation aneurysm in the right internal carotid artery.

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  Fig. 5 A : Immediately post treatment, working view unsubstracted right ICA angiography demonstrating a complete embolization. B : Working view demonstrating an optimal Y-stent deployment.

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  Fig. 6 Follow-up angiography was performed 13 months after treatment. Working unsubstracted view of right ICA angiography shows a no interval change after initial treatment.

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