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Efficacy and safety of low profile stents in Y-stent assisted coil embolization of wide-necked bifurcation aneurysms: a systematic review and meta-analysis

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Abstract

Low-profile stents may provide significant advantages in Y-stent-assisted coiling due to their miniaturized design and capability to be delivered through a 0.0165-inch microcatheter. We aim to investigate the safety and efficacy of using these newer versions of stents in Y-stent-assisted coiling for the treatment of wide-necked bifurcation aneurysms. We conducted a systematic review of the PubMed, Embase, Cochrane Library, and Web of Science databases up to September 2023, following the PRISMA guidelines. Eligible studies included  ≥ 5 patients with intracranial wide-necked bifurcation aneurysms treated with Y-stent-assisted coiling using low-profile stents, providing angiographic and clinical outcomes. Two authors independently handled the search and selection. Primary outcomes were immediate and follow-up aneurysm occlusion, procedure-related complications, aneurysm recanalization, and retreatment. Secondary outcomes included technical success, procedure-related morbidity, procedure-related mortality, procedure-related stroke, and in-stent stenosis at follow-up. We analyzed the data using random-effects meta-analysis. In total, 19 studies including 507 patients with 509 aneurysms were included. 95% of the treated aneurysms were managed using the crossing Y-configuration. Technical success rate was 99%. Immediate adequate aneurysm occlusion was 90%. Follow-up angiographies were available for 443 aneurysms. The mean angiographic follow-up duration was 15.6 ± 1.9 months. The rates for follow-up adequate aneurysm occlusion and complete occlusion were 98% and 89%, respectively. After a mean clinical follow-up of 15 ± 2.4 months, a good clinical outcome was observed in 98% of patients. Overall, procedure-related morbidity and mortality rates were 1.3%, and 0.4%, respectively. Low-profile stents in Y-stent-assisted coiling outperform previous stent versions in terms of safety, efficacy, and technical success rates.

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Author notes

  1. Gabriele Ciccio is senior author.

Authors and Affiliations

  1. Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey

    Ahmet Gunkan

  2. Faculty of Medicine, Ninth July University, São Paulo, SP, Brazil

    Marcio Yuri Ferreira

  3. Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Sávio Batista

  4. Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt am Main, Germany

    Mohamed E. M. Fouad

  5. Department of Radiology, CHU de Saint Etienne, Saint Etienne, France

    Gabriele Ciccio

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  2. Marcio Yuri Ferreira
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Contributions

A.G.: original idea, systematic search, data extraction, statistical analysis, and manuscript writing. M.Y.F.: systematic search, data extraction,statistical analysis, manuscript writing. S.B.: manuscript writing, editing. M.E.M.F.: manuscript writing, editing. G.C.: supervision, review, editing.

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Correspondence to Ahmet Gunkan.

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Gunkan, A., Ferreira, M.Y., Batista, S. et al. Efficacy and safety of low profile stents in Y-stent assisted coil embolization of wide-necked bifurcation aneurysms: a systematic review and meta-analysis. Neurosurg Rev 47, 123 (2024). https://doi.org/10.1007/s10143-024-02343-x

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