Y-stent assisted coiling of bifurcation aneurysms with Enterprise stent: long-term follow-up

Limbucci, Nicola; Renieri, Leonardo; Nappini, Sergio; Consoli, Arturo; Rosi, Andréa; Mangiafico, Salvatore

doi:10.1136/neurintsurg-2014-011483

Cited by 61 publications

(45 citation statements)

References 27 publications

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“…The reported rates of immediate angiographic occlusion (RROC I or II) with Y-stentassisted coiling range from 52 to 100% [26][27][28][29][30][31]. In our series, immediate complete obliteration (RROC I-II) was achieved in 89.6% of the cases, similar to what has been described by Behme et al [5].…”

Section: Discussionsupporting

confidence: 75%

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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Section: Discussionsupporting

confidence: 75%

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

et al. 2018

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“…The initial occlusion rates progressed to 62.5% for RR1 and 37.5% for RR2 on short imaging follow-up, with none requiring retreatment. This is similar to the occlusion rates of 60–96% RR1 and 2–33% RR2 on imaging follow-up for Y-stenting 2 4 8. Thus, the ‘shelf’ technique appears to be a safe and effective alternative technique to Y-stenting based on the data from this small case series.…”

Section: Discussionsupporting

confidence: 79%

LVIS Jr ‘shelf’ technique: an alternative to Y stent-assisted aneurysm coiling

Shankar

2016

J NeuroIntervent Surg

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Wide-necked bifurcation intracranial aneurysms have traditionally not been amenable to coil embolization with the use of a single stent due to the high risk of coil prolapse. Y-configuration double stent-assisted coil embolization ('Y-stenting') of this aneurysm type has been shown to have generally good clinical outcomes, although the technique is complex with various challenges described in the literature. The compliant and flexible closed-cell design of braided stents such as the LVIS Jr allows for the creation of a 'shelf' across the aneurysm neck sufficient to prevent coil prolapse. We describe this novel 'shelf' technique and present a small case series of LVIS Jr stent-assisted wide-necked bifurcation intracranial aneurysm coiling in eight patients. Our small, albeit important, case series demonstrates that the 'shelf' technique is feasible and safe with very good short-term clinical and angiographic outcomes, and may obviate the need for Y-stenting.

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“…Stent-assisted approaches, including Y-stenting, have had success, but have also been associated with periprocedural and delayed complications 3 4. Other approaches, such as ‘waffle cone’ stenting, in which devices are used outside their intended purpose may be equally challenging.…”

Section: Discussionmentioning

confidence: 99%

Republished: Treatment of wide-necked basilar tip aneurysm not amenable to Y-stenting using the PulseRider device

Sheth

Patel

Ismail

et al. 2015

J NeuroIntervent Surg

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SUMMARYEndovascular treatment of broad-necked bifurcation aneurysms remains challenging. Stent-assisted coiling has been successful but requires catheterization of the branches off the parent vessel. We present the case of a patient who failed primary and stent-assisted coiling of a large basilar tip aneurysm because the morphology of the aneurysm precluded successful distal catheterization of the posterior cerebral artery (PCA) branches. Using the PulseRider device, which does not require catheterization of bifurcation branches, we were able to treat the aneurysm successfully. BACKGROUND

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Y-stent assisted coiling of bifurcation aneurysms with Enterprise stent: long-term follow-up

Cited by 61 publications

References 27 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

LVIS Jr ‘shelf’ technique: an alternative to Y stent-assisted aneurysm coiling

Republished: Treatment of wide-necked basilar tip aneurysm not amenable to Y-stenting using the PulseRider device

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