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. 2021 Oct;27(5):638-647.
doi: 10.1177/15910199211005331. Epub 2021 Mar 28.

Y-stent assisted coiling of ruptured wide neck intracranial aneurysm in the acute phase

İsmail Okan Yıldırım  1 , Mehmet Kolu  2 , Mehmet Akif Durak  3 , Bora Tetik  3 , Ramazan Paşahan  3 , Şükrü Gürbüz  4 , Kaya Saraç  1
Affiliations

Y-stent assisted coiling of ruptured wide neck intracranial aneurysm in the acute phase

İsmail Okan Yıldırım et al. Interv Neuroradiol. 2021 Oct.

Abstract

Background: The objective of the present study is to analyze the outcomes of patients with subarachnoid hemorrhage (SAH) in the acute phase after treatment with Y-stent-assisted coiling (YSAC) embolization.

Methods: This retrospective study assessed of 30 patients with acutely ruptured wide-neck aneurysms following YSAC treatment between April 2013 and October 2019. The demographic data, aneurysm occlusion grade, procedural and periprocedural complications, and clinical outcomes were assessed.

Results: The procedure was completed in 30 cases (90.1%) and technical failure occurred in 3 cases (9.1%). Immediate control angiography revealed that total occlusion Raymond-Ray Class 1 (RR1) was achieved in 21 (70%), neck filling (RR2) in eight (26.6%) and sac filling (RR1) in one (3.3%) aneurysm. Upon angiographic follow-up, RR1 occlusion was observed in 15 (71.4%) patients, RR2 in three (14.3%) patients and RR3 in three (14.3%) patients. In-stent thrombus developed in five (16.6%) patients; procedural ischemic events were observed in four (13.3%) patients; and two (6.6%) patients were symptomatic. A periprocedural asymptomatic intracranial hemorrhage was detected in two patients. At discharge, 17 (56.6%) patients were in good clinical condition, six (20%) were in a severe disability condition, and seven (23.3%) patients had died. At the final follow-up visit (mean: 18.9 months), 16 (76,2%) of 21 patients were in a good clinical condition and five (23.8%) had severe disabilities.

Conclusions: Y-stent assisted coiling in might be a feasible and promising option for treatment in acute phase in selected wide-necked ruptured intracranial aneurysms.

Keywords: Aneurysm; ruptured; stents.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(a–e) 3D image (a) shows a wide-neck small aneurysm at the MCA bifurcation. Digital subtraction angiography (b and c) shows stent trombosis during YSAC procedure and patency provided after intra-arterial tirofiban administration. Follow-up postoperatif diffusion-weighted image (d) shows an acute infarct in the MCA superior division territory and this patient was discharged with GOS 3. 1 year later this patient was in good clinical condition and CT angiography shows (e) patency of both stents.
Figure 2.
Figure 2.
(a–e) (A) patient with Fisher grade 3/Hunt & Hess grade 2 subarachnoid hemorrhage. Non-Contrast CT image show (a) a large localized clot adjacent to the aneurysm. DSA and 3D image (b and c) show a complex wide-neck aneurysm at the right MCA bifurcation. Immediate angiography (d) shows RR1 total occlusion of the aneurysm after a YSAC (Neuroform Atlas) procedure. 1-year follow-up angiography shows (e) RR3 recanalization of the aneurysm.
Figure 3.
Figure 3.
(a–d) (A) A patient with Fisher grade 3, Hunt & Hess grade 2 subarachnoid hemorrhage. Wide-neck basilar top aneurysm treated with embolization using dual Enterprice stents VasoCT image shows (a) stent position and RR1 total occlusion of aneurysm and 1-year follow-up angiography (b) shows that recanalization is not observed in the aneurysm. (B) A another patient with Fisher grade-4, H&H grade-3 patient. A 12-mm wide-neck basilar top aneurysm treated with embolization using dual Neuroform Atlas stents. Immediate angiography (c) shows RR1 occlusion of aneurysm and 1-year follow-up Magnetic Resonance angiography (d) shows recanalization of the aneurysm (white arrow).
See this image and copyright information in PMC

References

    1. Debrun GM, Aletich VA, Kehrli P, et al. Selection of cerebral aneurysms for treatment using Guglielmi detachable coils: the preliminary University of Illinois at Chicago experience. Neurosurgery 1998; 43: 1281–1295. - PubMed
    1. Cekirge HS, Yavuz K, Geyik S, et al. HyperForm balloon remodeling in the endovascular treatment of anterior cerebral, middle cerebral, and anterior communicating artery aneurysms: clinical and angiographic follow-up results in 800 consecutive patients. J Neurosurg 2011; 114: 944–953. - PubMed
    1. Mocco J, Snyder KV, Albuquerque FC, et al. Treatment of intracranial aneurysms with the enterprise stent: a multicenter registry. J Neurosurg 2009; 110: 35–39. - PubMed
    1. Bodily KD, Cloft HJ, Lanzino G, et al. Stent-assisted coiling in acutely ruptured intracranial aneurysms: a qualitative, systematic review of the literature. AJNR Am J Neuroradiol 2011; 32: 1232–1236. - PMC - PubMed
    1. Kwon O-K, Kim SH, Oh CW, et al. Embolization of wide-necked aneurysms with using three or more microcatheters. Acta Neurochir (Wien) 2006; 148: 1139–1145. - PubMed

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