BACKGROUND: Y-stent-assisted coiling for wide-neck intracranial aneurysms required further investigation. PURPOSE:Our aim was to analyze outcomes after Y-stent placement in wide-neck aneurysms. DATA SOURCES:We performed a systematic search of 3 data bases for studies published from 2000 to 2018. STUDY SELECTION:According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting Y-stent-assisted coiling of wide-neck aneurysms.DATA ANALYSIS: Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and factors influencing the studied outcomes. DATA SYNTHESIS:We included 27 studies and 750 aneurysms treated with Y-stent placement. The immediate complete/near-complete occlusion rate was 82.2% (352/468; 95% CI, 71.4%-93%; I 2 ϭ 92%), whereas the long-term complete/near-complete occlusion rate was 95.4% (564/598; 95% CI, 93.7%-97%; I 2 ϭ 0%) (mean radiologic follow-up of 14 months). The aneurysm recanalization rate was 3% (20/496; 95% CI, 1.5%-4.5%; I 2 ϭ 0%), and half of the recanalized aneurysms required retreatment. The treatment-related complication rate was 8.9% (63/614; 95% CI, 5.8%-12.1%; I 2 ϭ 44%). Morbidity and mortality after treatment were 2.4% (18/540; 95% CI, 1.2%-3.7%; I 2 ϭ 0%) and 1.1% (5/668; 95% CI, 0.3%-1.9%; I 2 ϭ 0%), respectively. Crossing Y-stent placement was associated with a slightly lower complication rate compared with the kissing configuration (56/572 ϭ 8.4%; 95% CI, 5%-11%; I 2 ϭ 46% versus 4/30 ϭ 12.7%; 95% CI, 3%-24%; I 2 ϭ 0%). Occlusion rates were quite comparable among Enterprise, Neuroform, and LVIS stents, whereas the Enterprise stent was associated with lower rates of complications (8/89 ϭ 6.5%; 95% CI, 1.6%-11%; I 2 ϭ 0%) compared with the others (20/131 ϭ 14%; 95% CI, 5%-26%; I 2 ϭ 69% and 9/64 ϭ 11%; 95% CI, 3%-20%; I 2 ϭ 18%). LIMITATIONS:This was a small, retrospective series. CONCLUSIONS: Y-stent-assisted coiling yields high rates of long-term angiographic occlusion, with a relatively low rate of treatmentrelated complications. Y-stent placement with a crossing configuration appears to be associated with better outcomes. Although Y-configuration can be obtained using many types of stents with comparable occlusion rates, the Enterprise stent is associated with lower complication rates.ABBREVIATIONS: IQR ϭ interquartile range; PRISMA ϭ Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SAC ϭ stent-assisted coiling;Y-SAC ϭ Y-stent-assisted coiling W ith the improvement of angiographic imaging, operator experience, and widespread use of more complex techniques, an increased number of intracranial aneurysms can be effectively treated with endovascular techniques. However, aneurysms with wide necks, unfavorable anatomic configurations, and partial incorporation of bifurcation branches are still challenging lesions for endovascular treatment, and each technique presents specific limitations. Balloon-assisted coiling may not be suitable in case of very wide-neck aneu...

Flow diverter devices have gained wide acceptance for the treatment of unruptured intracranial aneurysms. Most studies are based on the treatment of large aneurysms harboring on the carotid syphon. However, during the last years the “off-label” use of these stents has widely grown up even if not supported by randomized studies. This review examines the relevant literature concerning “off-label” indications for flow diverter devices, such as for distal aneurysms, bifurcation aneurysms, small aneurysms, recurrent aneurysms, and direct carotid cavernous fistulas.

No abstract

BACKGROUND: Flow diversion for anterior communicating artery aneurysms required further investigation. PURPOSE: Our aim was to analyze outcomes after treatment of anterior communicating artery aneurysms with flow-diverter stents. DATA SOURCES: A systematic search of 3 data bases was performed for studies published from 2008 to 2018. STUDY SELECTION: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting anterior communicating artery aneurysms treated with flow diversion. DATA ANALYSIS: Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and factors influencing the studied outcomes. DATA SYNTHESIS: We included 14 studies and 148 unruptured saccular anterior communicating artery aneurysms treated with flow diversion. The long-term complete/near-complete (O'Kelly-Marotta C-D) occlusion rate was 87.4% (91/105; 95% CI, 81.3%-93.6%; I 2 ϭ 0%) (mean radiologic follow-up of 11 months). The treatment-related complication rate was 8.6% (14/126; 95% CI, 4%-13.1%; I 2 ϭ 0%), with morbidity and mortality rates of 3.5% (5/126; 95% CI, 2%-7%; I 2 ϭ 0%) and 2.5% (2/148; 95% CI, 0.3%-5%; I 2 ϭ 0%), respectively. Most complications were periprocedural (12/126 ϭ 7%; 95% CI, 3%-11%; I 2 ϭ 0%). Thromboembolic events were slightly higher compared with hemorrhagic complications (10/126 ϭ 6%; 95% CI, 2%-10%; I 2 ϭ 0% and 4/126 ϭ 3%; 95% CI, 1%-6%; I 2 ϭ 0%). Branching arteries (A2 or the recurrent artery of Heubner) covered by the stent were occluded in 16% (7/34; 95% CI, 3.5%-28%; I 2 ϭ 25%) of cases. Pre-and posttreatment low-dose and high-dose of antiplatelet therapy was not associated with significantly different complication and occlusion rates. LIMITATIONS: We reviewed small and retrospective series. CONCLUSIONS: Flow diversion for unruptured saccular anterior communicating artery aneurysms appears to be an effective alternative treatment for lesions difficult to treat with coiling or microsurgical clipping. The treatment-related complication rate was relatively low. However, larger studies are needed to confirm these results. ABBREVIATIONS: AcomA ϭ anterior communicating artery; ASA ϭ acetylsalicylic acid; AT ϭ antiplatelet therapy; CP ϭ clopidogrel; IQR ϭ interquartile range; OKM ϭ O'Kelly-Marotta; PRISMA ϭ Preferred Reporting Items for Systematic Reviews and Meta-Analyses