Purpose Stent-assisted endovascular treatment of intracranial aneurysms is currently performed in many endovascular centers. Unfortunately, some parent vessel bifurcation aneurysms are not treatable with single-stent-assisted coiling. Recently, small series presented a novel treatment using double-stents in “Y” and “X” configuration. We present our experience with “Y” and “X” stent-assisted coiling of wide necked intracranial aneurysms, with emphasis on clinical and angiographic outcomes.
Materials and Methods Clinical and angiographic outcomes of 44 patients harboring 50 intracranial aneurysms, treated with “Y” and “X” stent-assisted coiling in 47 procedures from June 2006 to October 2010, were retrospectively analyzed.
Results We treated 44 patients (11 men and 33 women, ages ranging from 35 to 78, average: 54 years), harboring 50 aneurysms (sac sizes from 2.1 mm to 22.0 mm, mean: 8.0 mm; neck sizes from 1.8 mm to 10.7 mm, mean: 5.6 mm), 52.0% (26/50) localized at the middle cerebral artery bifurcation, 26.0% (13/50) on the anterior communicating artery and 22.0% (11/50) at the apex of the basilar artery, in 47 procedures. Clinical presentations were: incidental discovery 68.0% (34/50), recanalyzations of previously coiled aneurysms 24.0% (12/50), subarachnoid hemorrhages 8.0% (4/50). All but 1 procedure (in cases of acutely ruptured aneurysm) were carried out under full heparinization and dual antiplatelet medication (clopidogrel and aspirin). In 1 case of acutely ruptured aneurysm abciximab was administrated intra-arterially and intravenously during the procedure, aspirin and clopidogrel being started after the treatment. We performed 47 procedures, 89.4% (42/47) with “Y” stenting, 6.4% (3/47) with “X” stenting, while 4.2% (2/47) attempted stenting failed. Out of 45 successful procedures, we delivered the stents before coiling in 89.9% (40/45), after in 8.9% (4/45), without coils in 2.2% (1/45). Complications associated with transitory or reversible neurological deficit (<7 days) were encountered in 10.6% (5/47) of the procedures, while permanent neurological deficits were noted in 10.6% (5/47) of the procedures. The 10 procedure-related complications were the following: 2 stent occlusions, 4 thromboembolisms, 3 intraprocedural ruptures and 1 intraparenchymal hematoma. There were no cases of procedure-related mortality. The immediate angiographic controls showed a complete occlusion in 60.0% (30/50) of the aneurysms, a partial (neck or sac remnant) occlusion in 40.0% (20/50). On clinical follow-up, the modified Rankin Scale score was 0 in 88.6% (39/44) of the patients, 1 in 4.5% (2/44), 3 in 4.5% (2/44) and 4 in 6.8% (3/44). To date, 52.0% (26/50) of the aneurysms had been followed up (average: 18 months) with angiography, disclosing a recanalyzation in 15.4% (4/26) and an improvement in 34.6% (9/26). No aneurysm (re)bled during the follow-up period.
Conclusion “Y” and “X” stent-assisted coiling of wide-necked bifurcation intracranial aneurysms is a feasible and effective technique for endovascular treatment of wide-necked bifurcation aneurysms. However, we encountered a high rate of complication with permanent neurological deficits. These clinical results should be balanced with those of surgical series. Improvement of stent design and technology may improve the procedural safety in the future.
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