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

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Department of Neurosurgery, Froedtert Hospital & The Medical College of Wisconsin, Milwaukee, WI, 53226, USA

    Andrew Lozen

  2. Department of Neurosurgery, Wayne State University, Detroit, MI, 48201, USA

    Sunil Manjila & Richard Rhiew

  3. Department of Neurosurgery, Providence Hospital, Southfield, MI, 48075, USA

    Richard Fessler

  4. Department of Neurosurgery, 9200 West Wisconsin Ave., Milwaukee, WI, 53226, USA

    Andrew Lozen

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  1. Andrew Lozen
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  2. Sunil Manjila
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  3. Richard Rhiew
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  4. Richard Fessler
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Correspondence to Andrew Lozen.

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Comment

So far, microsurgery has been in most cases of large and giant aneurysms the treatment of choice because of the high risk of re-canalization after endovascular treatment which may furthermore be contraindicated because of an existing thrombus. With new development of stents some of the previously uncoilable aneurysms that may have also been difficult to treat with microsurgery may become coilable. However, very promising early results and enthusiasm may turn into disappointments after long-term follow-up. As the techniques and recommendations in endovascular therapy are constantly changing with new equipment coming to the market every month, it may be difficult to look back after 10–20 years as the current stents may be considered to be from the time of dinosaurs and not even worth analyzing at that time. During this time, so many other new techniques/devices will be used in different combinations each with a relatively small number of patients. Most likely, no real comparison between different methods will ever be done and only the latest equipment will be recommended by the endovascular society and industry. It will be interesting and important to see what happens inside and around the stent after several decades. Will we see parental artery occlusions or stents migrating out of the vessel wall? However, if the new stents and technology also work in the long-run, they are a welcome adjunct in the treatment of these challenging lesions and may even replace microsurgical treatment in many cases.

Mika Niemelä

Juha Hernesniemi

Helsinki, Finland

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Lozen, A., Manjila, S., Rhiew, R. et al. Y-stent-assisted coil embolization for the management of unruptured cerebral aneurysms: report of six cases. Acta Neurochir 151, 1663–1672 (2009). https://doi.org/10.1007/s00701-009-0436-9

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