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Hemorrhagic Stroke
Original research
Stent-assisted coiling of cerebral aneurysms using the Y-stenting technique: a systematic review and meta-analysis
  1. Manuel F Granja1,
  2. Gustavo M Cortez1,
  3. Pedro Aguilar-Salinas2,
  4. Guilherme Jose Agnoletto1,
  5. Gregory Imbarrato1,
  6. Alejandra Jaume3,
  7. Amin Aghaebrahim1,
  8. Eric Sauvageau1,
  9. Ricardo A Hanel1
  1. 1 Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
  2. 2 Department of Neurosurgery, University of Arizona, Tucson, Arizona, USA
  3. 3 Maciel Hospital, Montevideo, Uruguay
  1. Correspondence to Dr Ricardo A Hanel, Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville FL 32207, USA; rhanel{at}lyerlyneuro.com

Abstract

Background Bifurcation aneurysms can be treated with stent-assisted coiling using two stents in a Y-configuration. We aim to investigate the angiographic and clinical outcomes of Y-stent constructs for the treatment of intracranial aneurysms.

Methods A systematic review of PubMed, Ovid MEDLINE, and Ovid EMBASE databases was conducted based on PRISMA guidelines. The study selection was performed using the ‘Ryyan’ application. Our analysis included 18 studies with 327 patients. Inclusion criteria were: articles published from January 2000 to November 2017, English language, including cerebral aneurysms treated via Y-stenting, and ≥5 cases with radiographic/clinical outcomes. Technical notes, editorials, reviews, and animal studies were excluded. A random-effect meta-analysis was performed on angiographic and clinical outcomes, including aneurysm occlusion, modified Rankin Scale, neurological outcome, and procedure-related mortality. 95% CIs and event rates were estimated. Statistical heterogeneity was assessed using I2 statistics.

Results The procedure-related good outcome rate was 92% and complete occlusion rate was 91%. The permanent neurological deficit rate was 4% and procedure-related mortality was 2%. The procedure-related stroke rate was 12%. A total of 28/146 (19%) patients had ruptured aneurysms. At long-term follow-up, overall stroke rate was 9% in patients with unruptured aneurysm. The mortality rate was higher in cases with ruptured aneurysms than in those with unruptured aneurysms (18% vs 0.8%; p<0.001).

Conclusions Y-stenting for bifurcation aneurysms yields a high rate of complete occlusion and low rates of mortality and stroke. Careful patient selection is needed.

  • intracranial aneurysm
  • stent
  • intervention

https://doi.org/10.1136/neurintsurg-2018-014517

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    Footnotes

    • Contributors MFG: manuscript writing, editing and statistical analysis. GMC: data gathering, editing and statistical analysis. PA-S: original idea, manuscript editing. GJA: manuscript writing, editing. AJ: manuscript writing, editing. GI: manuscript writing, editing. AA: manuscript writing, editing. RAH: original idea, manuscript writing, editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests RAH is a consultant for Medtronic, Stryker, Codman, and MicroVention.

    • Patient consent Not required.

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

    • Data sharing statement All data is published in the current version of this manuscript.