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Original research
Vascular angular remodeling by kissing-Y stenting in wide necked intracranial bifurcation aneurysms
  1. Katharina Melber1,
  2. Dan Meila1,2,
  3. Philipp Draheim1,
  4. Dominik Grieb1,
  5. Björn Greling1,
  6. Martin Schlunz-Hendann1,
  7. Friedhelm Brassel1
  1. 1Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany
  2. 2Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany
  1. Correspondence to Dr K Melber, Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Zu den Rehwiesen 9, D-47055 Duisburg, Germany, katharina.melber{at}yahoo.com

Abstract

Introduction Single stent deployment leads to a change in vascular geometry in wide necked bifurcation aneurysms. In some complex cases, the use of the single stent technique might not be sufficient or may not be feasible. The kissing-Y stenting technique appears to be an alternative endovascular treatment option. The aim of this study was to evaluate the effects of the kissing-Y stenting technique on vascular angular remodeling.

Methods 21 patients with wide necked intracranial bifurcation aneurysms at different sites (10 anterior communicating artery, 6 middle cerebral artery, 3 basilar artery, 1 vertebral artery/posterior inferior cerebellar artery, 1 internal carotid artery/posterior communicating artery) were treated with 44 closed cell stents (follow-up 2012–2016) using the kissing-Y stenting technique. We analyzed vascular angle geometry between the mother and both affected daughter vessels by digital subtraction angiography, before and after stent deployment, using standard working projections.

Results Endovascular treatment of wide necked intracranial aneurysms using the kissing-Y stenting technique significantly decreased the angle between the bifurcation branches from 130.4±9.5° to 91.5±9.1° (p<0.0001).

Conclusions 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.

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Footnotes

  • Contributors KM: acquired, analyzed, and interpreted the data for the work; designed the study; drafted the initial manuscript; and approved the final manuscript as submitted. DM: conceptualized the study; analyzed and interpreted the data for the work; critically revised the manuscript; and approved the final manuscript as submitted. PD: designed the study; acquired, analyzed, and interpreted the data for the work; and approved the final manuscript as submitted. DG and BG: acquired, analyzed, and interpreted the data for the work; and approved the final manuscript as submitted. MS-H: acquired, analyzed, and interpreted the data for the work; revised the manuscript; and approved the final manuscript as submitted. FB: conceptualized the study; analyzed and interpreted the data for the work; drafted the manuscript and revised it critically; and approved the final manuscript as submitted. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Ethics approval Approval for the study was obtained from the local hospital's institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors agree to share data on request.

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