Vascular angular remodeling by kissing-Y stenting in wide necked intracranial bifurcation aneurysms

Melber, Katharina; Meila, Dan; Draheim, Philipp; Grieb, Dominik; Greling, Björn; Schlunz-Hendann, Martin; Brassel, Friedhelm

doi:10.1136/neurintsurg-2016-012858

Cited by 11 publications

(13 citation statements)

References 13 publications

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“…3) [6,7]. Moreover, the flow diversion effect of Y-stenting or even of LVIS Jr alone could result in successful and stable aneurysm occlusion without aneurysm coiling [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

LVIS Jr Device for Y-Stent-Assisted Coil Embolization of Wide-Neck Intracranial Aneurysms: A Multicenter Experience

et al. 2018

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Background and Purpose: Complex wide-neck intracranial aneurysms are challenging to treat. We report a multicenter experience using the LVIS Jr stent for “Y-stent”-assisted coiling embolization of wide-neck bifurcation aneurysms. Methods: Seven centers provided retrospective data on patients who underwent Y-stenting. Technical complications, immediate posttreatment angiographic results, clinical outcomes, and imaging follow-up were assessed. Results: Thirty patients/aneurysms were treated: 15 basilar tip, 8 middle cerebral artery, 4 anterior communicating artery, 1 pericallosal, and 2 posterior inferior cerebellar artery aneurysms. The mean aneurysm size was 11 mm and the mean dome-to-neck ratio was 1.3 mm. Twenty-four aneurysms were unruptured and treated electively, and 6 were acutely ruptured. Fifty-eight LVIS Jr stents were successfully deployed without any technical issue. One procedural and transient in-stent thrombosis resolved with the intravenous infusion of a glycoprotein IIb/IIIa inhibitor. Five periprocedural complications (within 30 days) occurred: 2 periprocedural neurological complications (1 small temporal stroke that presented with transient aphasia and 1 posterior cerebral artery infarct) and 3 nonneurological periprocedural complications (2 retroperitoneal hematomas, and 1 patient developed a disseminated intravascular coagulopathy). One permanent complication (3.3%) directly related to Y-stenting was reported in the patient who suffered the posterior cerebral artery infarct. Immediate complete obliteration (Raymond-Roy Occlusion Classification [RROC] I–II) was achieved in 26 cases (89.6%). Twenty-four patients had clinical and imaging follow-up (mean 5.2 months). Complete angiographic occlusion (RROC I–II) was observed in 23 patients (96%). A good functional outcome with a modified Rankin Scale score ≤2 was achieved in 26 cases. Conclusions: In this multicenter case series, Y-stent-assisted coiling of wide-neck aneurysms with the LVIS Jr device was feasible and relatively safe. Follow-up imaging demonstrated very low recanalization rates.

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“…3) [6,7]. Moreover, the flow diversion effect of Y-stenting or even of LVIS Jr alone could result in successful and stable aneurysm occlusion without aneurysm coiling [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

LVIS Jr Device for Y-Stent-Assisted Coil Embolization of Wide-Neck Intracranial Aneurysms: A Multicenter Experience

et al. 2018

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“…In order to determine the effect of stent assistance in larger aneurysms we compared the change in radius of curvature and aneurysm-tilt-angle in aneurysms ≥10 mm (n=22) treated with or without stent assistance. There was no significant difference in these parameters based on addition of a stent and we did not measure immediate post-stent geometric changes as published previously 7 8. However, a difference could be missed because of the small sample size.…”

Section: Resultsmentioning

confidence: 83%

“…The addition of stents can alter the configuration of the PCAs in relation to the basilar apex, potentially narrowing the bifurcation angle 7 8. Whether this leads to reduced aneurysm recurrence is unproven but stent-assisted coiling does allow for a higher packing density16 that may indirectly reduce recurrences.…”

Section: Discussionmentioning

confidence: 99%

The ’bendy' basilar: progressive aneurysm tilting and arterial deformation can be a delayed outcome after coiling of large basilar apex aneurysms

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Tarabishy

Boo

et al. 2018

J NeuroIntervent Surg

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“…14 This technique offers many advantages in aneurysm remodeling such as support to prevent coil protrusion, a blood flow-diversion effect, a scaffold for neo-endothelization, modification of the parent vessel-aneurysm geometry and remodeling of the affected branches. 15,16 It allows the complete exclusion of the aneurysms in 92.3% of cases, 14 with a complication rate between 11 and 31.6%, 17,18 most of which related to thromboembolic events. However, a comparison study between unassisted coiling, single-stent assisted-coiling and Y-stent coiling of BTA showed similar percentages of thromboembolic complications (respectively 6.8%, 6.9% and 6.2%) with higher complication rate (respectively 9.5%, 9.7% and 6.2%) and recanalization rate (respectively 38.9%, 19.2% and 8.3%) in single-stent assisted coiling.…”

Section: Discussionmentioning

confidence: 99%

Neuroform Atlas stent deployment through the Barrel vascular reconstruction device for the treatment of a wide-necked acutely ruptured basilar aneurysm

et al. 2018

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Background The Barrel vascular reconstruction device is an electrolytically detachable laser-cut closed-cell stent used for neck reconstruction in wide-necked bifurcation aneurysms to support coiling without necessitating dual stent implantation. The purpose is to lower the metal-to-artery ratio and its inherent risk of thromboembolic complications of multiple stents. Case description A 53-year-old woman presenting with subarachnoid hemorrhage due to acutely ruptured basilar tip aneurysm underwent emergency endovascular embolization with the Barrel vascular reconstruction device. Since the stent did not cover the entire neck of the aneurysm, an Atlas stent was released in a Y configuration through the Barrel. The Neuroform Atlas correctly opened through the Barrel and allowed the complete exclusion of the aneurysm. Conclusion If necessary, releasing a Neuroform Atlas through a Barrel vascular reconstruction device is a feasible technique.

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Vascular angular remodeling by kissing-Y stenting in wide necked intracranial bifurcation aneurysms

Abstract: Kissing-Y stenting in wide necked bifurcation aneurysms leads to vascular angular remodeling of both affected branches. The resulting straightening of the bifurcation angle may prevent aneurysmal recurrence.

Cited by 11 publications

References 13 publications

LVIS Jr Device for Y-Stent-Assisted Coil Embolization of Wide-Neck Intracranial Aneurysms: A Multicenter Experience

LVIS Jr Device for Y-Stent-Assisted Coil Embolization of Wide-Neck Intracranial Aneurysms: A Multicenter Experience

The ’bendy' basilar: progressive aneurysm tilting and arterial deformation can be a delayed outcome after coiling of large basilar apex aneurysms

Neuroform Atlas stent deployment through the Barrel vascular reconstruction device for the treatment of a wide-necked acutely ruptured basilar aneurysm

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