Abstract W P69: Y and X Stent-Assisted Coiling of Complex and Wide-Neck Bifurcation Aneurysms in 100 Procedures
Purpose: Stent-assisted coiling with two stents in Y or X configuration has been described in some series for the treatment of complex and wide-neck bifurcation aneurysms. Our purpose is to present our experience with double stents in “X” and “Y” configurations, with emphasis on safety, feasibility and efficacy.
Methods: Clinical and angiographic outcomes of patients for whom the strategic therapeutic chosen option was the stent-assisted coiling technique in “Y” and “X” fashion to reconstruct the neck from June 2006 to June 2013, were retrospectively analyzed from our prospectively gathered database.
Results: One hundred and five aneurysms in 97 patients were treated during 100 consecutive procedures. There were 54.2% (57/105) MCA, 28.6% (30/105) AcoA, 16.2% (17/105) basilar tip and 1.0% (1/105) ICA termination aneurysms. Clinical presentations were: incidental discovery 75.2% (79/105), compression 1.0% (1/105), recurrences of previously coiled aneurysms 19.0% (20/105), SAH 4.7% (5/105). A “Y” stenting was used to treat 87 aneurysms in 85 procedures; a “X” stenting was used to treat 7 aneurysms in 6 procedures, while 9 procedures failed for 11 aneurysms. Permanent neurological deficits were noted in 11.0% (11/100) of the procedures, including 1 death. Immediate complete occlusions were noted in 47.6% (50/105) of the aneurysms, partial (neck or sac remnant) occlusions in 52.4% (55/105). To date, 74.3% (78/105) of the aneurysms had been followed up (mean: 16 months) with DSA, disclosing a recanalization in 4.8% (5/105), and an improvement in 34.3% (36/105). No aneurysm (re)bled during the follow-up period.
Conclusions: “Y” and “X” stent-assisted coiling of complex bifurcation intracranial aneurysms is a feasible and effective technique for endovascular treatment of wide-neck bifurcation aneurysms. However, we encountered a high rate of complications with permanent neurological deficits. Improvement of stent design and newer antiplatelet drugs may improve the procedural safety in the future.
Author Disclosures: B. Bartolini: Consultant/Advisory Board; Modest; Covidien, Stryker. R. Blanc: Consultant/Advisory Board; Modest; Covidien, Stryker. S. Pistocchi: Consultant/Advisory Board; Modest; Covidien, Stryker. H. Redjem: Consultant/Advisory Board; Modest; Covidien, Stryker. M. Piotin: Consultant/Advisory Board; Modest; Covidien, Stryker.
- © 2014 by American Heart Association, Inc.