Coil treatment of a fusiform upper basilar trunk aneurysm with a combination of ?kissing? neuroform stents, TriSpan-, 3D- and fibered coils, and permanent implantation of the microguidewires

Abstract

Endovascular coil occlusion of fusiform intracranial aneurysms without sacrifice of the parent artery can be technically challenging. Bridging of wide aneurysm necks with stents is common practice for side-wall aneurysms but is less frequently used for bifurcation aneurysms. We describe the technical aspects of the successful coil occlusion of a fusiform aneurysm of the upper basilar trunk, with preservation of the parent vessel. The procedure comprised the following steps: (a) stenting of the left V1- and proximal V2 segments; (b) simultaneous deployment of two Neuroform stents from both P1 segments down to the basilar artery ("kissing" stents) (c) using a TriSpan device to hold (d) three-dimensional electrolytically detachable coils in place and (e) filling the aneurysmal lumen mainly with fibered electrolytically detachable coils; and finally (f) cutting the extracorporeal part of both microguidewires below the skin level in both groins, leaving the microguidewires as they were used for the deployment of the stents in place, thus reaching from both P2 segments down to the basilar artery and further proximally.

Y-Configuration Stent Placement (Crossing and Kissing) for Endovascular Treatment of Wide-Neck Cerebral Aneurysms Located at 4 Different Bifurcation Sites

“…However, achieving an uncomplicated and complete obliteration of complex bifurcation aneu- rysms remains technically challenging. Currently, the Y-stent technique, including the crossing-Y 2,6,12 and kissing-Y, 3 is increasingly emerging as a promising therapeutic option for some complex bifurcation aneurysms. However, its efficacy and safety remain unclear.…”

“…In 2004, the kissing-stent technique was attempted for a BA apex aneurysm, resulting in permanent implantation of the microguidewires, 3 which was not a successful kissing-stent technique. In our current series, we reported 2 cases of BA apex aneurysms reconstructed by using the kissing-Y stent technique, which are actually the first successful cases ever reported (Fig 4), to our knowledge.…”

“…[1][2][3][4][5][6] However, it remains a challenge to successfully treat some complex wide-neck bifurcation aneurysms by using a single-stent technique. Although kissing-balloon-assisted coiling has been attempted, 7,8 this technique is almost impossible for treating extremely wide-neck bifurcation aneurysms such as those reported in this article.…”

“…11 According to some series, in some complex bifurcation aneurysms, especially those in which the base of the aneurysm directly involves both bifurcation branches, a better option may be preserving both branches by using the Y-stent technique. 2,3,12 However, its safety remains yet unknown. The purpose of this study was to evaluate the efficacy and safety of the Y-stent technique and to report our experiences based on 11 cases.…”

A Comparison of Functional and Physical Properties of Self-Expanding Intracranial Stents [Neuroform3, Wingspan, Solitaire, Leo(+), Enterprise]

“…In our experience, in-stent stenosis after stent-assisted coiling of aneurysms is generally rare but seems to be increased in patients with underlying vasculitis. Bifurcation reconstruction can be achieved with both " crossing " and " kissing " using Neuroform stents [30,31] . The Wingspan stent was originally developed for the endovascular treatment of intracranial atherosclerotic stenoses [5] .…”