Y-stenting with braided stents for wide-neck intracranial bifurcation aneurysms. A single-center initial experience - 31/01/19

Doi : 10.1016/j.neurad.2018.12.005

Cristian Mihalea ^a,^b,^⁎ , Jildaz Caroff ^a, Leon Ikka ^a, Nidhal Benachour ^a, Valerio Da Ros ^a, Hazem Abdelkhalek ^a,^c, Marta Iacobucci ^a, Joaquin Jose Marenco de la Torre ^a, Igor Pagiola ^a,^d, Thomas Yasuda ^a, Bogdan Valeriu Popa ^e, Horia Ples ^b, Sorin Pescariu ^f, Jacques Moret ^a, Laurent Spelle ^a
^a Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, AP–HP, Paris Sud Université, 94270 Le Kremlin-Bicêtre, France
^b Department of Neurosurgery, University of Medicine and Pharmacy “Victor-Babes” Timisoara, Romania
^c Department of Neuropsychiatry, Tanta University Hospital, Tanta, Egypt
^d Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
^e Department of Radiology and Medical Imaging, “Floreasca” Clinical Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
^f Cardiology Department, “Victor-Babes” University of Medicine and Pharmacy, Timisoara, Romania

^⁎Corresponding author at: Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, AP–HP, Paris Sud Université, Le Kremlin-Bicêtre, France.Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hopital Bicetre, AP–HP, Paris Sud UniversitéLe Kremlin-BicêtreFrance

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Abstract

Introduction

The treatment of wide-neck bifurcation aneurysms is still challenging despite the use of new techniques, such as Y-stenting, the waffle-cone technique and intrasaccular flow disrupters, in recent years. Moreover, the use of flow diverter stents in bifurcation aneurysms has been proposed by several teams, although the results remain controversial. This study aims to evaluate the feasibility and efficacy of Y-stent assisted coiling of bifurcation aneurysms with braided stents.

Methods

We retrospectively reviewed all patients in whom Y-stenting with braided stents had been performed in our center. Six patients were identified and analyzed. Technical success, complications, angiographic outcomes, procedural data, and follow-up controls are reported here. This study was approved by our local ethical committee.

Results

Technical success was achieved in all procedures. Overall procedure-related morbidity and mortality was 0%. In the immediate post-treatment angiography, adequate occlusion (neck remnant or total occlusion) was observed in all patients. Short- and long-term follow-up angiography showed adequate occlusion of the aneurysms.

Conclusions

In this small, retrospective single-center analysis we showed that Y-stent assisted coiling with braided stents is a safe and feasible technique. Moreover, it has a high immediate occlusion rate and very good long-term stability.

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