Y-Stent-Assisted Coil Embolization of Wide-Neck Intracranial Aneurysms

Abstract

<jats:p> This report evaluated the short and midterm results of the safety and effectiveness of the treatment technique with hybrid and non-hybrid Y-configured, dual stent-assisted coil embolization of wide-neck intracranial aneurysms, and reviewed the literature concerning this technique. </jats:p><jats:p> Nine patients, eight with unruptured and one with ruptured aneurysms were included in the study. Of aneurysms embolized with a hybrid (with two different stents) and non-hybrid (with two identical stents) technique, three were located in the anterior communicating artery, three at the tip and one at the distal site of basilar artery, and two in the middle cerebral artery. All aneurysms included the orifices of bifurcation vessels. All aneurysms were stented and embolized during the same session. While Neuroform and Enterprise stents were used in the hybrid technique, two Enterprise stents were used in the non-hybrid technique. </jats:p><jats:p> Dual Y-stent assisted coil embolization was performed successfully in eight of nine patients (88.9%), including five patients (55.6%) with hybrid and three patients (33.3%) with non-hybrid technique. No procedural complication, no mortality and no minor or major neurological complications were seen during the angiographic or clinical follow-up. When an attempt was made at passing the second stent through the first Enterprise stent, the stent protruded inside the aneurysm in one patient (11.1%). </jats:p><jats:p> Hybrid or non-hybrid dual Y-stent-assisted coil embolization in the treatment of ruptured or unruptured wide-neck and complex intracranial aneurysms is a safe and effective method from the viewpoint of short and midterm results. </jats:p>

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

“…These excellent results demonstrated the efficacy and durability of the Y-stent technique for intracranial bifurcation aneurysms, which coincided with the findings in recently published literature. 21,22 In this series, the success rate of the techniques associated with the crossing-Y or kissing-Y stent was 100%. Although a thrombus event (1/11) resulting from a coil loop protrusion was encountered in case 2 (Fig 1), a salvaging Y-stent was used, achieving the patency of double branches.…”

Analysis of Closed-Cell Intracranial Stent Characteristics Using Cone-Beam Computed Tomography With Contrast Material

“…1) Stent protrusion into the aneurysm occurred in one of the non-hybrid cases (11.1%). 1) With regard to the prevention of stent slip, deployment of a second stent in another session might be effective. 17) The other two Y-configuration cases in our series underwent a second intervention for stabilization of the first stent, and we were able to deploy the second stent at the appropriate position.…”

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.…”

“…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. The narrowed structure focally lowered the porosity of the stent (Fig 2).…”

“…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.…”