PT  - JOURNAL ARTICLE
AU  - Manuel F Granja
AU  - Gustavo M Cortez
AU  - Pedro Aguilar-Salinas
AU  - Guilherme Jose Agnoletto
AU  - Gregory Imbarrato
AU  - Alejandra Jaume
AU  - Amin Aghaebrahim
AU  - Eric Sauvageau
AU  - Ricardo A Hanel
TI  - Stent-assisted coiling of cerebral aneurysms using the Y-stenting technique: a systematic review and meta-analysis
AID  - 10.1136/neurintsurg-2018-014517
DP  - 2019 Jul 01
TA  - Journal of NeuroInterventional Surgery
PG  - 683--689
VI  - 11
IP  - 7
4099  - http://jnis.bmj.com/content/11/7/683.short
4100  - http://jnis.bmj.com/content/11/7/683.full
SO  - J NeuroIntervent Surg2019 Jul 01; 11
AB  - 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.