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Original research
Y-stent assisted coiling of bifurcation aneurysms with Enterprise stent: long-term follow-up
  1. Nicola Limbucci,
  2. Leonardo Renieri,
  3. Sergio Nappini,
  4. Arturo Consoli,
  5. Andrea Rosi,
  6. Salvatore Mangiafico
  1. Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy
  1. Correspondence to Dr Nicola Limbucci, Interventional Neuroradiology Unit, AOU Careggi, CTO, Largo P Palagi 1, Florence 50134, Italy; nicolalimb{at}gmail.com

Abstract

Background Y-stent assisted coiling has been proposed for the treatment of wide-neck bifurcation aneurysms, but there are many technical variations. We report our single-center experience of Y-stent assisted coiling of bifurcation aneurysms with the closed cell Enterprise stent in order to evaluate the safety and long-term results of this technique. The literature on Y-stenting and its hemodynamic effects are reviewed.

Methods Fifty-two consecutive patients with wide-neck bifurcation aneurysms underwent Y-stent assisted coiling with two Enterprise stents. The procedure was completed in 48 cases (92.3%) and technical failure occurred in 4 cases (7.3%). Cases performed with other stents were excluded. All procedures were performed under double antiplatelet therapy. Periodic clinical and neuroradiological follow-up was performed.

Results Mean neuroradiological follow-up time was 26 months. Complete immediate occlusion was obtained in 87.5% of patients. Two remnants had regrown at follow-up and were recoiled, achieving complete occlusion. The late neuroradiological occlusion rate was: complete occlusion 93.6%, neck remnant 4.3%, sac remnant 2.1%. No in-stent stenosis was detected at follow-up. Among the 48 procedures, two complications occurred (4.2%). Mortality was 2.1%. No delayed ischemic stroke occurred.

Conclusions Y-stent assisted coiling has a high immediate occlusion rate and very good long-term stability. The procedure is relatively safe, although the complication and mortality rates are not negligible. Two Enterprise stents can be safely used for Y-stenting and, indeed, offer the advantage of easier catheterization, delivery and deployment into distal and tortuous vessels than open cell stents.

  • Stent
  • Aneurysm
  • Intervention
  • Technique

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