Introduction Despite advances in surgical and endovascular treatment of intracranial aneurysms, the management of wide necked basilar tip aneurysms poses substantial treatment challenges. Y stenting, in which one stent is deployed through the side wall tines of a previously placed stent, is a feasible adjunct to coiling of these aneurysms. Case series describing this technique are small with limited follow-up. We describe our experience with the Y stent assisted, coil embolization of basilar tip aneurysms in the largest case series to date with medium term follow-up data.
Methods A review of our prospectively maintained database from 2004 to 2009 was performed to assess technical factors associated with treatment, complications and radiographic follow-up of patients undergoing Y stenting for basilar apex aneurysms.
Results 11 patients with wide necked basilar tip aneurysms were treated. Average follow-up was 13 months. Post-procedure surveillance was carried out by MR angiography (n=6), cerebral angiogram (n=9) or CT angiography (n=1), with several patients undergoing multiple types of radiographic follow-up. All patients’ aneurysms were completely or nearly completely (>95%) occluded at the time of treatment. No patient required retreatment. One patient suffered an asymptomatic vertebral artery dissection that required stenting and another suffered a minor stroke but recovered completely.
Conclusion Y stenting is a viable treatment modality for this complex subgroup of aneurysms. Our series demonstrated the safety of this technique, with no patients suffering permanent complications. While the efficacy of Y stenting has yet to be established, medium term radiographic follow-up suggests durable results.
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Competing interests FA—Micrus, EV3, Advanced Medical Devices Inc.