Abstract WP81: Outcomes Following X- and Y-Configuration Stent-Assisted Coil Embolization of 52 Complex Bifurcation Cerebral Aneurysms
Background: Wide-neck bifurcation cerebral aneurysms pose technical challenges in endovascular therapy. Intersecting stents are used with increasing frequency. Periprocedural, clinical, and mid-term angiographic outcomes of this approach are not well known. We report clinical and angiographic outcomes in our use of the X- and Y-configuration techniques.
Methods: We reviewed a retrospectively collected database to identify all aneurysm cases in which an X- or Y-configuration stent technique was used. Demographic, periprocedural and mid-term clinical and imaging data were collected. Outcomes included rate of thromboembolic events (TEE), intraoperative perforations (IOP), mortality, aneurysm residual at the time of the procedure and recurrence observed at follow-up.
Results: Among 807 cerebral aneurysms, we identified 52 aneurysms in 50 patients treated with X- or Y-configuration stent implantation. Mean age was 58 years (SD = 10) with 34 (65%) women. Aneurysm locations were basilar artery (n = 20), MCA (n = 13), ACA (n = 16), and ICA (n = 3). Mean aneurysm maximum diameter was 7.0 mm (SD 2.9) and the mean neck size was 4.5 mm (SD = 1.7). Fifty cases (96%) involved “Y” configuration, and two cases (4%) used an “X” configuration. Aneurysm catheterization technique was trans-stent in all cases (vs jailing). Interstices catheterization required a wire or catheter change in 13 (25%) cases. Immediate results revealed complete occlusion in 45 (86.5%), residual aneurysm in 3 (5.7%), and residual neck in 4 (7.7%). There were no mortalities, and 7 (13.5%) TEEs, of which 2 (4%) were symptomatic. There were 2 (4%) asymptomatic IOPs. Imaging follow-up was available for 40 (77%) cases, with mean interval from index procedure of 5.7 months. This mid-term outcome showed complete obliteration in 28 (70%) cases, residual neck in 8 (20%), and residual aneurysm in 4 (10%).
Conclusions: These results suggest that placement of intersecting stents in X- and Y-configurations for coil embolization of wide-neck bifurcation cerebral aneurysms is feasible and can be performed with acceptable procedural safety and good rates of aneurysm occlusion.
- © 2012 by American Heart Association, Inc.