Y-configuration double-stent-assisted coiling using two closed-cell stents for wide-neck basilar tip aneurysms
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This study aimed to evaluate clinical and angiographic outcomes of Y-configuration double-stent-assisted (Y-stent) coiling using two closed-cell stents for wide-necked basilar tip aneurysm (BTA).
A total of 25 patients underwent Y-stent coiling using two closed-cell stents as a first-time treatment in 18 (3 ruptured) BTAs, retreatment in 2 BTAs and as a third treatment in 5 wide-necked BTAs. Clinical and angiographic outcomes were evaluated retrospectively.
Treatment-related complications were three (12.0 %) thromboembolic infarctions due to two acute in-stent thromboses and one embolism. Twenty-two (88 %) patients had favorable outcomes (modified Rankin scale score [mRS], 0–2) during the follow-up period (mean, 30 months; range, 6–54 months). Two patients died: one from initial subarachnoid hemorrhage and the other from intracerebral hemorrhage due to underlying Moyamoya disease. Post-treatment angiograms showed complete occlusion in nine aneurysms, residual neck in 11 aneurysms and residual sac in five aneurysms. Follow-up angiograms were available at least once between 5 to 34 months (mean, 16 months) in 21 patients. Nineteen patients showed improved or stable states (complete occlusion, n = 17; residual neck, n = 2). Major recurrences occurred in two BTAs (9.5 %). Those two major recurrent aneurysms had been large-sized aneurysms at the initial coiling procedure. Both showed not only coil compaction but also progressive growth to giant-sized aneurysms and intra-aneurysmal thrombus formation at the Y-stent coiling as a third-time treatment.
Y-stent coiling using two closed-cell stents is a safe and durable treatment option for wide-necked BTA, but may have limited efficacy for large/giant sized and thrombosed aneurysms.
KeywordsAneurysm Basilar artery Coiling Stent-assistance
Conflict of interest
- 1.Lee CY, Kim CH (2014) Very late stent thrombosis following the placement of a crossing Y-stent with dual closed-cell stents for the coiling of a wide-neck aneurysm. J Neurointervent Sug. doi: 10.1136/neurintsurg-2013-011036.rep
- 3.Chalouhi N, Jabbour P, Gonzalez LF, Dumont AS, Rosenwasser R, Starke RM, Gordon D, Hann S, Tjoumakaris S (2012) Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance: a review of 235 cases. Neurosurgery 71:785–794PubMedCrossRefGoogle Scholar
- 4.Heller RS, Rahal JP, Malek AM (2014) Y-stent embolization technique for intracranial bifurcation aneurysms. J Clin Neurosci. doi: 10.1016/j.jocn.2013.11.0028
- 9.Becske T, Kallmes DF, Saatci I, McDougall CG, Szikora I, Lanzino G, Moran CJ, Woo HH, Lopes DK, Berez AL, Cher DJ, Siddiqui AH, Levy EI, Albuquerque FC, Fiorella DJ, Berentei Z, Marosfoi M, Cekirge SH, Nelson PK (2013) Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial. Radiology 267:858–868PubMedCrossRefGoogle Scholar
- 15.Kulcsar Z, Ernemann U, Wetzel SG, Bock A, Goericke S, Panagiotopoulos V, Forsting M, Ruefenacht DA, Wanke I (2010) High-profile flow diverter (Silk) implantation in the basilar artery: efficacy in the treatment of aneurysms and the role of perforators. Stroke 41:1690–1696PubMedCrossRefGoogle Scholar
- 16.Chalouhi N, Jabbour P, Singhal S, Drueding R, Starke RM, Dalyai RT, Tjoumakaris S, Gonzalez LF, Dumont AS, Rosenwasser R, Randazzo CG (2013) Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke 44:1348–1353PubMedCrossRefGoogle Scholar
- 20.Fargen KM, Mocco J, Neal D, Dewan MC, Reavery-Cantwell J, Woo HH, Fiorella DJ, Mokin M, Siddiqui AH, Turk AS, Turner RD, Chaudry I, Kalani MY, Albuquerque F, Hoh BL (2013) A multicenter study of stent-assisted coiling of cerebral aneurysms with a Y-configuration. Neurosurgery 73:466–472PubMedCrossRefGoogle Scholar
- 23.Horowitz M, Levy E, Sauvageau E, Genevro J, Guterman LR, Hanel R, Wehman C, Gupta R, Jovin T (2006) Intra/extra-aneurysmal stent placement for management of complex and wide-necked-bifurcation aneurysms: eight cases using the waffle cone technique. Neurosurgery 58(2):258–262Google Scholar