J Cerebrovasc Endovasc Neurosurg.  2016 Dec;18(4):355-362. 10.7461/jcen.2016.18.4.355.

Y-configuration Stent-assisted Coil Embolization for Wide-necked Intracranial Bifurcation Aneurysms

• Lee K
• Park H
• Park I
• Park SQ
• Kwon OK
• Han J

• KMID: 2367326
• DOI: http://doi.org/10.7461/jcen.2016.18.4.355

Abstract

OBJECTIVE
The objective of this study was to determine the efficiency and safety of Y configuration stent-assisted coiling with double-closed stents for wide-necked intracranial aneurysms located at arterial bifurcations thorough analysis of a multicenter case series.
MATERIALS AND METHODS
A retrospective chart review was done on 10 patients who underwent endovascular treatment of wide-necked intracranial aneurysms with Y-configuration stent-assisted coil embolization in three centers from August 2011 to March 2014. The degree of aneurysmal occlusion was assessed using the Raymond scale. Clinical outcomes were assessed before operation, at discharge, and at the last follow-up visit using the Glasgow outcome scale.
RESULTS
The 10 patients included 6 females and 4 males with a mean age of 58.6 years. Indications for treatment included 6 unruptured intracranial aneurysms and 4 ruptured intracranial aneurysms. Five aneurysms were located at the basilar artery bifurcation, four aneurysms were located in an anterior communicating artery, and one aneurysm was in the pericallosal artery. The mean size of the 10 aneurysms was 9.7 mm. All aneurysms had a dome-to-neck ratio of < 1.5 (mean, 0.89). Immediate complications included one thromboembolic event out of the 10 cases. Immediate posttreatment angiograms showed complete occlusion in 1 aneurysm and residual necks in 9 aneurysms. Follow-up results showed 8 complete occlusions and 2 residual necks. No delayed complications were observed during the follow-up period (mean: 20 months).
CONCLUSION
Y configuration using double-closed cell stents is feasible and safe in selected patients. This method is an acceptable option for managing complex wide-necked bifurcations.

Keyword

Cerebral aneurysm; Closed cell stent; Y-stent-assisted coil embolization; Wide-necked aneurysm

MeSH Terms

Aneurysm*
Arteries
Basilar Artery
Embolization, Therapeutic*
Female
Follow-Up Studies
Glasgow Outcome Scale
Humans
Intracranial Aneurysm
Male
Methods
Neck
Retrospective Studies
Stents

Figure

• 

  Fig. 1 A 44-year-old woman with an unruptured pericallosal bifurcation aneurysm. (A) 3D rotational reconstruction image produced by cerebral angiography showing an approximately 5 mm sized wide-necked basilar bifurcation aneurysm. (B) A completely occluded necked aneurysm after a Y configuration-assisted double stent procedure using closed cell-type stents. (C) Complete occlusion of the aneurysm on follow-up conventional angiography performed after 23 months.

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