Acta Neurochirurgica

, Volume 151, Issue 12, pp 1663–1672 | Cite as

Y-stent-assisted coil embolization for the management of unruptured cerebral aneurysms: report of six cases

  • Andrew Lozen
  • Sunil Manjila
  • Richard Rhiew
  • Richard Fessler
Neurosurgical Techniques



The advent of stent-assisted coil embolization has revolutionized the endovascular management of complex intracranial aneurysms. Although performed routinely in most cerebrovascular centers, there are not many case series reported about the Y-stent technique for coil placement in cerebral aneurysms. The authors present the second largest series available within the neurosurgical literature.


The authors have retrospectively reviewed the medical records and angiographic data of six patients who were diagnosed as having unruptured cerebral aneurysms and subsequently treated using "Y" stent-assisted coil embolization. Five out of six cerebral aneurysms in this study were located at the basilar tip while the remaining one was at the left MCA trifurcation. Aneurysms ranged in size from 8–22 mm. All patients were female with ages ranging from 37–70 years. One patient presented with recurrence of an aneurysm previously managed with a balloon-assisted coil embolization. Another patient presented after a failed trial of a balloon-assisted procedure. One patient had originally been diagnosed with multiple aneurysms of varying size and location.


A “Y” configuration was successfully established in all six patients. Five patients have had a symptom-free recovery period at average follow-up period of 36.7 months. The remaining patient is notable for recurrence that was discovered on angiogram 32 months postoperatively.


The proposed Y-stent technique is a safe and effective option that can be employed in the endovascular reconstruction of unruptured intracranial aneurysms of complex location and orientation. These methods serve as an acceptable alternative in the management of aneurysms traditionally managed with microsurgery. Hemodynamic assessment has shown Y-stenting to be an advantageous therapy option, yet further studies are required to assess these parameters in alternative therapies.


Basilar Artery Coil Embolization Parent Artery Arterial Bifurcation Unruptured Cerebral Aneurysm 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



  1. 1.
    Ahlhelm F, Roth C, Kaufmann R, Schulte-Altedorneburg G, Romeike B, Reith W (2007) Treatment of wide-necked intracranial aneurysms with a novel self-expanding two-zonal endovascular stent device. Neuroradiology :17703295. PSEBDGoogle Scholar
  2. 2.
    Aletich VA, Debrun GM, Misra M, Charbel F, Ausman JI (2000) The remodeling technique of balloon-assisted detachable coil placement in wide-necked aneurysms: experience at the University of Chicago. J Neurosurg 93(3):388–396CrossRefPubMedGoogle Scholar
  3. 3.
    Banerjee RK, Gonzalez CF, Cho YI, Picard L (1996) Hemodynamic changes in recurrent intracranial terminal aneurysm after endovascular treatment. Acad Radiol 3(3):202–211. doi: 10.1016/S1076-6332(96)80441-7 CrossRefPubMedGoogle Scholar
  4. 4.
    Cantón G, Levy DI, Lasheras JC (2005) Hemodynamic changes due to stent placement in bifurcating intracranial aneurysms. J Neurosurg 103(1):146–155CrossRefPubMedGoogle Scholar
  5. 5.
    Cha KS, Balaras E, Lieber BB, Sadasivan C, Wakhloo AK (2007) Modeling the interaction of coils with the local blood flow after coil embolization of intracranial aneurysms. J Biomech Eng 129(6):873–879. doi: 10.1115/1.2800773 CrossRefPubMedGoogle Scholar
  6. 6.
    Cohen JE, Gomori JM, Umansky F (2003) Endovascular management of symptomatic vertebral artery dissection achieved using stent angioplasty and emboli protection device 25:418–422Google Scholar
  7. 7.
    Cross DT, Moran CJ, Derdeyn CP, Mazumdar A, River D, Chicoine MM (2005) Neroform stent deployment for treatment of a basilar tip aneurysm via posterior communicating artery route. AJNR Am J Neuroradiol 26:2578–2581PubMedGoogle Scholar
  8. 8.
    de Paula Lucas C, Piotin M, Spelle L, Moret J (2008) Sten-jack technique in stent-assisted coiling of wide-necked aneurysms. Neurosurgery 62(2):ONS414–ONS416 ONS416-7PubMedCrossRefGoogle Scholar
  9. 9.
    Fiehler J, Byrne JV (2009) Factors effecting outcome after endovascular treatment of intracranial aneurysms. Curr Opin Neurosurg 22(1):103–108. doi: 10.1097/WCO.0b013e32831af1c1 CrossRefGoogle Scholar
  10. 10.
    Fiorella D, Albuquerque FC, Felipe C, Woo H, Rasussen PA, Peter A, Masaryk TJ, Cameron G (2006) Neuroform in-stent stenosis: incidence, natural history and treatment strategies. Neurosurgery 59(1):34–42. doi: 10.1227/01.NEU.0000219853.56553.71 CrossRefPubMedGoogle Scholar
  11. 11.
    Fiorella D, Albuquerque FC, Masaryk TJ, Rasmussen PA, McDougall CG (2005) Balloon-in-stent technique for the constructive endovascular treatment of “ultra-wide necked” circumferential aneurysms. Neurosurgery 57(6):1218–1227. doi: 10.1227/01.NEU.0000186036.35823.10 CrossRefPubMedGoogle Scholar
  12. 12.
    Fineschi M, Gori T (2008) Vary late thrombosis in a bare metal stent: an under-recognized problem. Can J Cardiol 24(2):e6–e7PubMedGoogle Scholar
  13. 13.
    Flores-Ríos X, Marzoa-Rivas R, Abugattás-de Torres JP, Piñón-Esteban P, Aldama-López G, Salgado-Fernández J, Calviño-Santos R, Vázquez-Rodríguez JM, Vázquez-González N, Castro-Beiras A (2008) Late thrombosis of paclitaxel-eluting stents: long-term incidence, clinical consequences, and risk factors in a cohort of 604 patients. Am Coll Cardiol 51(16):1543–1552. doi: 10.1016/j.jacc.2008.01.020 CrossRefGoogle Scholar
  14. 14.
    Gomez CR, Misra VK, Liu MW et al (2000) Elective stenting of basilar artery stenosis. Stroke 31:95–99PubMedGoogle Scholar
  15. 15.
    Hayashi K, Kitagawa N, Yoshioka T, Morikawa M, Ochi M, Kaminogo M, Shibata S (2002) A case of basilar artery stenosis treated by stent placement. No To Shinkei 54:527–531PubMedGoogle Scholar
  16. 16.
    He Y, Duraiswamy N, Frank AO, Moore JE Jr (2005) Blood flow in stented arteries: a parametric comparison of strut design patterns in three dimensions. J Biomech Eng 127(4):637–647. doi: 10.1115/1.1934122 CrossRefPubMedGoogle Scholar
  17. 17.
    Heros RC (2006) Complications of balloon-assisted coil embolization of intracranial aneurysms. J Neurosurg 105(3):396–399. doi: 10.3171/jns.2006.105.3.393 CrossRefGoogle Scholar
  18. 18.
    Horowitz M, Levy E, Sauvageau E, Genevro J, Guterman LR, Hanel R, Wehman C, Gupta R, Jovin T (2006) Inta/extra-aneurysmal stent placement for management of complex and wide-necked bifurcation aneurysms: eight cases using the waffle cone technique. Neurosurgery 58(2):258–262CrossRefGoogle Scholar
  19. 19.
    Horowitz MB, Pride GL, Graybeal DF, Purdy PD (1999) Percutaneous transluminal angioplasty and stenting of midbasilar stenosis: three case reports and literature review. Neurosurgery 45:925–930. doi: 10.1097/00006123-199910000-00043 CrossRefPubMedGoogle Scholar
  20. 20.
    Howington JU, Hanel RA, Harringan MR, Levy EI, Guterman LR, Hopkins LN (2004) The Neuroform stent, the first microcatheter-delivered stent for use in the intracranial circulation. Neurosurgery 54(1):2–5. doi: 10.1227/01.NEU.0000099370.05758.4D CrossRefPubMedGoogle Scholar
  21. 21.
    Molyneux AJ, Kerr RS, Mee Yu L, Clarke M, Sneade M, Yarnold JA, Sandercock P (2005) International subarachnoid aneurysm trial (ISAT) of neurological clippings versus endovascular coiling in 2143 patients with ruptured intracranial aneurysm: a randomized comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817. doi: 10.1016/S0140-6736(05)67214-5 CrossRefPubMedGoogle Scholar
  22. 22.
    Irie K, Kawanishi M, Nagao S (2000) Balloon-assisted placement in wide-necked cerebral aneurysms: preliminary experience. Neurol Med Chir (Tokyo) 40(12):603–608. doi: 10.2176/nmc.40.603 CrossRefGoogle Scholar
  23. 23.
    Joseph GJ, Goldstein J, Cloft H, Tong F, Dion J (2000) Endovascular stenting of arthrosclerotic stenosis in a basilar artery after successful angioplasty. AJR Am J Roentgenol 174:383–385PubMedGoogle Scholar
  24. 24.
    Kelly ME, Turner R, Gonugunta V, Woo HH, Rasumussen PA, Masaryk TJ, Fiorella D (2007) Stent reconstruction of wide-necked aneurysms across the circle of Willis. Neurosurgery 61(5):249–254. doi: 10.1227/01.neu.0000303977.04128.3e Suppl 2CrossRefPubMedGoogle Scholar
  25. 25.
    Kim M, Levy EI, Meng H, Hopkins L (2007) Quantification of hemodynamic changes induced by virtual placement of multiple stents across a wide-necked basilar trunk aneurysm. Neurosurgery 61(6):1305–1312. doi: 10.1227/01.neu.0000306110.55174.30 CrossRefPubMedGoogle Scholar
  26. 26.
    Kipshidze N, Dangas G, Tsapenko M, Moses J, Leon MB, Kutryk M, Serruys P (2004) Role of endothelium in modulating neointimal formation: vasculoprotective approaches to attenuate restenosis after percutaneous coronary interventions. J Am Coll Cardiol 44:733–739PubMedGoogle Scholar
  27. 27.
    Lanzino G, Wakhloo AK, Fessler RD, Hartney ML, Guterman LR, Hopkins LN (1999) Efficacy and current limitations of internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg 91(4):538–546CrossRefPubMedGoogle Scholar
  28. 28.
    Lee YJ, Kim DJ, Suh SH, Lee SK, Kim J, Kim DI (2005) Stent-assisted embolization of intracranial wide-necked aneurysms. Neuroradiology 47(9):680–689. doi: 10.1007/s00234-005-1402-8 CrossRefPubMedGoogle Scholar
  29. 29.
    Levy DI, Ku A (2007) Balloon-assisted coil placement in wide-necked aneurysms. Technical note. J Neurosurg 86(4):724–727Google Scholar
  30. 30.
    El L, Boulos AS, Bendok BR et al (2002) Brainstem infarction after delayed thrombosis of a stented vertebral artery fusiform aneurysm case report. Neurosurgery 51:1280–1284. doi: 10.1097/00006123-200211000-00026 CrossRefGoogle Scholar
  31. 31.
    Lefkowitz MA, Gobin YP, Akiba Y, Duckwiler GR, Murayama Y, Gulielmi G, Martin NA, Vinuela F (1999) Balloon-assisted Guglielmi detachable coiling of wide-necked aneurysms: Part II-clinical results. Neurosurgery 45(3):531–537. doi: 10.1097/00006123-199909000-00024 CrossRefPubMedGoogle Scholar
  32. 32.
    Lopes DK, Ringer AJ, Boulos AS, Qureshi AI, Lieber BB, Guterman LR, Hopkins LN (2003) Fate of branch arteries after intracranial stenting. Neurosurgery 52(6):1275–1278. doi: 10.1227/01.NEU.0000064567.15270.27 CrossRefPubMedGoogle Scholar
  33. 33.
    Lusseveld E, Brilstra EH, Nijssen PC et al (2002) Endovascualr coiling versus neurosurgical clipping in patients with ruptured basilar tip aneurysm. J Neurosurg Psychiatry 73:591–593. doi: 10.1136/jnnp. 73.5.591 CrossRefGoogle Scholar
  34. 34.
    Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C (2002) Endovascular reconstruction of intracranial arteries by stent placement and combined technique. J Neurosurg 97:1306–1313CrossRefPubMedGoogle Scholar
  35. 35.
    Malek AM, Higasha RT, Halbach VV, Phatouros CC, Meyers PM, Dowd CF (1999) Tandem intracranial stent deployment for treatment of an iatrogenic, flow-limiting, basilar artery dissection: technical case report. Neurosurgery 45(4):919–924. doi: 10.1097/00006123-199910000-00042 CrossRefPubMedGoogle Scholar
  36. 36.
    Mericle RA, Wakhloo AK, Rodriguez R, Guterman LR, Hopkins LN (1997) Temporary balloon protection as an adjunct to endovascular coiling of wide-necked aneurysms: a technical note. Neurosurgery 41(4):975–978. doi: 10.1097/00006123-199710000-00045 CrossRefPubMedGoogle Scholar
  37. 37.
    Meyers FB (2006) Balloon-assisted coil embolization of intracranial aneurysms. J Neurosurg 105(3):392. doi: 10.3171/jns.2006.105.3.392 CrossRefGoogle Scholar
  38. 38.
    Mitchell P, Kerr R, Mendelow AD, Molyneux A (2008) Could late rebleeding overturn the superiority of cranial aneurysm coil embolization over clip ligation seen in the International Subarachnoid Aneurysm Trial? J Neurosurg 108(3):437–442. doi: 10.3171/JNS/2008/108/3/0437 CrossRefPubMedGoogle Scholar
  39. 39.
    Nakahara T, Sakamoto S, Hamasaki O, Sakoda K (2002) Stent-assisted angioplasty for intracranial atherosclerosis. Neuroradiology 44:706–710. doi: 10.1007/s00234-002-0794-y CrossRefPubMedGoogle Scholar
  40. 40.
    Nelson PK, Levy DI (2001) Balloon-assisted coil embolization of a wide-necked aneurysms of the internal carotid artery: medium-term angiographic and clinical follow-up in 22 patients. AJNR Am J Neuroradiol 22(1):19–26PubMedGoogle Scholar
  41. 41.
    Phatouros CC, Higashida RT, Malek AM et al (1999) Endovascualr stenting of an acutely thrombosed basilar artery: technical case report and review of literature. Neurosurgery 44:667–673. doi: 10.1097/00006123-199903000-00134 CrossRefPubMedGoogle Scholar
  42. 42.
    Phatouros CC, Sasaki TY, Higashida RT (2000) Stent-supported coil embolization: the treatment of fusiform and wide-necked aneurysms and pseudo-aneurysms. Neurosurgery 47:107–115. doi: 10.1097/00006123-200007000-00023 CrossRefPubMedGoogle Scholar
  43. 43.
    Perez-Arjona E, Fessler RD (2004) Basilar artery to bilateral posterior cerebral artery 'Y stenting' for endovascular reconstruction of wide-necked basilar apex aneurysms: report of three cases. Neurol Res 26(3):276–281. doi: 10.1179/016164104225013969 CrossRefPubMedGoogle Scholar
  44. 44.
    Price RF, Sellar R, Leung C, O’Sullivan MJ (1998) Traumatic arterial dissection and vertibrobasilar thrombosis successfully treated with endovascular thrombolysis and stenting. AJNR Am J Neuroradiol 19:1677–1680PubMedGoogle Scholar
  45. 45.
    Ross IB, Gurmeet SD (2006) Balloon assistance as a routine adjunct to the endovascular treatment of cerebral aneurysms. Surg Neurol 66(6):593–601. doi: 10.1016/j.surneu.2006.03.050 CrossRefPubMedGoogle Scholar
  46. 46.
    Ross IB, Gurmeet SD (2005) Complications of endovascular treatment of cerebral aneurysms. Surg Neurol 64(1):12–18. doi: 10.1016/j.surneu.2004.09.045 CrossRefPubMedGoogle Scholar
  47. 47.
    Sani S, Lopes DK (2005) Treatment of a middle cerebral artery bifurcation aneurysm using a double neuroform stent “Y” configuration and coil embolization: technical case report. Neurosurgery 57(1):E209. doi: 10.1227/01.NEU.0000163684.75204.CD CrossRefPubMedGoogle Scholar
  48. 48.
    Spreer J, Els T, Hetzel A et al (2002) Primary stenting as emergency therapy in acute basilar artery occlusion. Neuroradiology 44:791–795. doi: 10.1007/s00234-002-0798-7 CrossRefPubMedGoogle Scholar
  49. 49.
    Sluzewski M, van Rooij WJ, Beute GN, Nijssen PC (2006) Balloon-assisted coil embolization of intracranial aneurysms: incidence, complications, and angiography result. J Neurosurg 105(3):396–399. doi: 10.3171/jns.2006.105.3.396 CrossRefPubMedGoogle Scholar
  50. 50.
    Suzuki S, Tateshima S, Jahan R, Duckwiler GR, Murayama Y, Gonzalez NR, Frazee JG, Vinuela F (2009) Endovascular treatment of middle cerebral artery aneurysms with detachable coils: angiographic and clinical outcomes in 115 consecutive patients. Neurosurgery (March):6. E pubGoogle Scholar
  51. 51.
    Thorell WE, Chow MM, Woo HH, Masaryk TJ, Ramussen PA (2005) Y-configured stent-assisted coil embolization for the treatment of wide-necked basilar tip aneurysms. Neurosurgery 56(5):1035–1040PubMedGoogle Scholar
  52. 52.
    Vanninen R, Manninen H, Ronkainen A (2003) Broad-based intracranial aneurysms: thrombosis induced by stent placement. AJNR Am J Neuroradiol 24(2):263–266PubMedGoogle Scholar
  53. 53.
    Vallee JN, Aymard A, Vicaut E, Reis M, Merland JJ (2003) Endovascular treatment of basilar tip aneurysms with Guglielmi detachable coils: predictors of immediate and long-term results with multivariate analysis 6-year experience. Radiology 226(3):867–879. doi: 10.1148/radiol.2263011957 CrossRefPubMedGoogle Scholar
  54. 54.
    Wanke I, Doerfler A, Schoch B, Stolke D, Forsting M (2003) Treatment of wide-necked intracranial aneurysms with a self expanding stent system: initial clinical experience. AJNR Am J Neuroradiol 24:1192–1199PubMedGoogle Scholar
  55. 55.
    Wanke I, Gizewski E, Forsting M (2006) Horizontal stent placement plus coiling in a broad-based basilar tip aneurysm: an alternative to the Y-stent technique. Neuroradiology 48(11):817–820. doi: 10.1007/s00234-006-0128-6 CrossRefPubMedGoogle Scholar
  56. 56.
    Wells-Roth D, Biondi A, Janardhan V, Chapple K, Gobin YP, Riina HA (2005) Endovascular procedures for treating wide-necked aneurysms. Neurosurg Focus 15 18(2):E7Google Scholar
  57. 57.
    Yahia AM, Gordon V, Whapham J, Malek A, Steel J, Fessler RD (2008) Complications of Neuroform stent in endovascular treatment of intracranial aneurysms. Neurocrit Care 8(1):19–30. doi: 10.1007/s12028-007-9001-7 CrossRefPubMedGoogle Scholar
  58. 58.
    Yano S, Houkin K, Abe S et al (2001) Angioplasty with stenting for intracranial vertebral and basilar artery stenosis: three technical case reports and literature review. No Shinkei Geka 29:1081–1090PubMedGoogle Scholar
  59. 59.
    Zenteno M, Modensi Freitas JM, Aburto-Murrieta Y, Koppe G, Machado E, Lee A (2006) Balloon-expandable stenting with and without coiling for wide-necked and complex aneurysms. Surg Neurol 66(6):603–610. doi: 10.1016/j.surneu.2006.05.058 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Andrew Lozen
    • 1
    • 4
  • Sunil Manjila
    • 2
  • Richard Rhiew
    • 2
  • Richard Fessler
    • 3
  1. 1.Department of NeurosurgeryFroedtert Hospital & The Medical College of WisconsinMilwaukeeUSA
  2. 2.Department of NeurosurgeryWayne State UniversityDetroitUSA
  3. 3.Department of Neurosurgery, Providence HospitalSouthfieldUSA
  4. 4.Department of NeurosurgeryMilwaukeeUSA

Personalised recommendations