Initial and Long-Term Outcomes of Complex Bifurcation Aneurysms Treated by Y-Stent-Assisted Coiling with Low-Profile Braided Stents

Abstract

Background and purpose: Coiling complex intracranial bifurcation aneurysms often necessitates the implantation of double stents in various configurations, such as Y-stent placement. Low-profile braided stents have been introduced recently to facilitate the endovascular treatment of wide-neck aneurysms. We aimed to investigate the feasibility, safety, efficacy, and durability of Y-stent-assisted coiling with double low-profile braided stents for the treatment of complex bifurcation aneurysms.

Materials and methods: A retrospective review was performed to identify patients who were treated using Y-stent-assisted coiling with low-profile braided stents. Technical success was assessed, as were initial and follow-up clinical and angiographic outcomes. Periprocedural and delayed complications were reviewed. Preprocedural and follow-up clinical statuses were assessed using the modified Rankin Scale.

Results: Forty patients with 40 intracranial aneurysms were included in the study. Y-stent placement was successfully performed in all cases. Immediate postprocedural digital subtraction angiography images revealed total aneurysm occlusion in 72.5% of cases. The mean angiographic follow-up time was 24.8 months. The last follow-up angiograms showed complete occlusion in 85% of patients. During follow-up, only 1 patient showed an increase in the filling status of the aneurysm and that patient did not require retreatment. There was no mortality in this study. The overall procedure-related complication rate, including asymptomatic complications, was 17.5%. A permanent morbidity developed in 1 patient (2.5%).

Conclusions: The long-term angiographic and clinical outcomes of this retrospective study demonstrate that Y-stent-assisted coiling using low-profile braided stents is an effective, relatively safe, and durable endovascular treatment for wide-neck and complex bifurcation aneurysms.

Fig 1.

An illustration demonstrating the Y-stent-assisted coiling procedure using 2 braided stents.

Fig 2.

Procedural and follow-up angiographic images of a 58-year-old female patient with an unruptured MCA aneurysm. A, A preprocedural DSA image reveals a 12-mm, complex, wide-neck MCA bifurcation aneurysm. The neck of the aneurysm involves the origins of both daughter branches of the bifurcation. B, Immediate postprocedural DSA image shows that the aneurysm is completely occluded. C, Immediate postprocedural nonsubtracted angiogram obtained just before the contrast injection. The image shows the Y-configuration of the LEO Baby stents overlapping in the M1 segment of the MCA and extending into the upper (black arrow) and lower (white arrow) trunks of the MCA. D, A 12-month follow-up DSA image demonstrates complete occlusion of the aneurysm.

Fig 3.

Procedural and follow-up angiograms of a 23-year-old male patient with unruptured bilateral ICA bifurcation aneurysms. Y-stent placement was performed as a bailout procedure after coil protrusion and consequent thrombus development following a single stent-assisted coiling treatment. A and B, Preprocedural DSA and 3D reconstructed angiograms show a wide-neck 6-mm aneurysm (arrows) located at the left ICA bifurcation. C and D, Procedural control DSA and nonsubtracted angiograms show that the aneurysm has been coiled with the assistance of a single LEO Baby stent extending from the ICA to the left anterior cerebral artery. The coil mesh (arrows) protrudes into the M1 segment of the MCA. E, A procedural DSA image reveals the development of a thrombus (arrow) in the M1 segment of the MCA. F, DSA image obtained after a bailout deployment of a second LEO Baby stent into the MCA, creating a Y-configuration with the first stent. As shown in the image, the deployment of the second stent successfully treated the coil protrusion and restored the patency of the MCA. G and H, Nonsubtracted angiography and an MIP reconstruction image of flat panel CT show the Y-stent configuration with 2 LEO Baby stents. The images clearly show that there is no constriction of the second stent (deployed into the MCA) at the intersection point of the stents. I, A 12-month follow-up DSA image shows complete occlusion of the aneurysm and the patency of the stents.