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

Abstract

BACKGROUND AND PURPOSE:The Y-stent technique, including crossing-Y and kissing-Y, is a promising therapeutic option for some complex bifurcation aneurysms. Here, its efficacy and safety are evaluated on the basis of 11 bifurcation aneurysms.

Hemodynamics of 8 Different Configurations of Stenting for Bifurcation Aneurysms

“…2 Several reports mainly focusing on crossing-Y stents showed 0%-33.3% recanalization rates. 12,13,16,26 Most interesting, only crossing-Y stents using open-cell stents showed recanalization.…”

“…The aneurysm and vessels formed a cavity in the silicone model ( Fig 1A). We deployed closed-cell stents, 28-mm Enterprise (Cordis Neurovascular, Miami Lakes, Florida), in the silicone model in the following 7 different configurations (Fig 2): a single-stent placement from the basilar artery to the right or left PCA, a nonoverlapping-Y stent, 10 a horizontal stent, 7-9 a kissing-Y stent (doublestent placement in a parallel fashion), 11,12 and 2 different crossing-Y stents with a narrowed structure. 13,14,17 In 1 crossing-Y stent, crossing-Y (R to L), the first stent was deployed into the right PCA and the second stent was placed into the left PCA through the interstices of the first stent.…”

“…[1][2][3][4][5] However, recanalization rates of SACE are 8.1%-17.2% 2,4,5 ; therefore, these rates still need to be improved. In addition, various configurations of stentings have been proposed and performed for bifurcation aneurysms, including a single stent from a proximal to a distal vessel; a waffle-cone stent 6 ; a horizontal stent [7][8][9] ; a nonoverlapping-Y stent 10 ; a kissing (double-barrel) Y stent, in which both stents are deployed in a parallel fashion 11,12 ; and a crossing-Y stent, in which the second stent is deployed through the interstices of the first stent. [12][13][14][15][16][17][18] The differences in hemodynamics among these various configurations of stent placement are unclear, and this may be important for the recanalization rate.…”

“…In addition, various configurations of stentings have been proposed and performed for bifurcation aneurysms, including a single stent from a proximal to a distal vessel; a waffle-cone stent 6 ; a horizontal stent [7][8][9] ; a nonoverlapping-Y stent 10 ; a kissing (double-barrel) Y stent, in which both stents are deployed in a parallel fashion 11,12 ; and a crossing-Y stent, in which the second stent is deployed through the interstices of the first stent. [12][13][14][15][16][17][18] The differences in hemodynamics among these various configurations of stent placement are unclear, and this may be important for the recanalization rate. In crossing-Y stents, use of double closed-cell stents causes narrowing of the second stent through the interstices of the first stent, 17 while using an open-cell stent as the first stent can avoid this effect of narrowing.…”

Flow-Diverter Stents for the Treatment of Saccular Middle Cerebral Artery Bifurcation Aneurysms

“…4 Furthermore, wide-neck MCA bifurcation lesions can sometimes prove challenging for traditional EVT approaches, and numerous techniques have been developed to address these cases. Simple coil embolization and remodeling techniques, including single-balloon-or multiple-balloon-assisted coiling 5,6 ; the dual-catheter technique 7 ; stent-assisted coiling [8][9][10] ; the "Y-stent placement" technique with and without coiling 11,12 ; the "waffle cone" technique 13,14 ; neck-bridge devices 15,16 ; and intra-aneurysmal flow disrupters 17,18 have all been trialed. Flow-diverter stents (FDSs) have proved feasible, safe, and efficient for the treatment of large and broad-neck carotid siphon aneurysms.…”