Endovascular treatment of wide-neck intracranial bifurcation aneurysms with ‘Y’-configuration, double Neuroform® stents-assisted coiling technique: Experience in a single center

Castaño, Carlos; Terceño, Mikel; Remollo, Sebastián; García-Sort, M R; Domínguez, C.

doi:10.1177/1591019917708568

Cited by 19 publications

(11 citation statements)

References 24 publications

(54 reference statements)

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“…Although infrequently specified in the included studies, most Neuroform stents were the older generation devices. Castaño et al 26 described a series of patients treated with different generations of Neuroform stents, including the Neuroform Atlas Stent System in past years, reporting 95% occlusion and a very low rate of treatment-related complications (2.5%) after Y-stent placement. The authors reported that in their experience, open-cell stents had good conformability to tortuous anatomies, minor rectification of the vessels, high vessel wall apposition, and easier microcatheterization through the mesh of the first stent.…”

Section: Closed-cell and Open-cell Stentsmentioning

confidence: 99%

Y-Stent-Assisted Coiling of Wide-Neck Bifurcation Intracranial Aneurysms: A Meta-Analysis

Cagnazzo

Limbucci

Nappini

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND: Y-stent-assisted coiling for wide-neck intracranial aneurysms required further investigation. PURPOSE:Our aim was to analyze outcomes after Y-stent placement in wide-neck aneurysms. DATA SOURCES:We performed a systematic search of 3 data bases for studies published from 2000 to 2018. STUDY SELECTION:According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting Y-stent-assisted coiling of wide-neck aneurysms.DATA ANALYSIS: Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and factors influencing the studied outcomes. DATA SYNTHESIS:We included 27 studies and 750 aneurysms treated with Y-stent placement. The immediate complete/near-complete occlusion rate was 82.2% (352/468; 95% CI, 71.4%-93%; I 2 ϭ 92%), whereas the long-term complete/near-complete occlusion rate was 95.4% (564/598; 95% CI, 93.7%-97%; I 2 ϭ 0%) (mean radiologic follow-up of 14 months). The aneurysm recanalization rate was 3% (20/496; 95% CI, 1.5%-4.5%; I 2 ϭ 0%), and half of the recanalized aneurysms required retreatment. The treatment-related complication rate was 8.9% (63/614; 95% CI, 5.8%-12.1%; I 2 ϭ 44%). Morbidity and mortality after treatment were 2.4% (18/540; 95% CI, 1.2%-3.7%; I 2 ϭ 0%) and 1.1% (5/668; 95% CI, 0.3%-1.9%; I 2 ϭ 0%), respectively. Crossing Y-stent placement was associated with a slightly lower complication rate compared with the kissing configuration (56/572 ϭ 8.4%; 95% CI, 5%-11%; I 2 ϭ 46% versus 4/30 ϭ 12.7%; 95% CI, 3%-24%; I 2 ϭ 0%). Occlusion rates were quite comparable among Enterprise, Neuroform, and LVIS stents, whereas the Enterprise stent was associated with lower rates of complications (8/89 ϭ 6.5%; 95% CI, 1.6%-11%; I 2 ϭ 0%) compared with the others (20/131 ϭ 14%; 95% CI, 5%-26%; I 2 ϭ 69% and 9/64 ϭ 11%; 95% CI, 3%-20%; I 2 ϭ 18%). LIMITATIONS:This was a small, retrospective series. CONCLUSIONS: Y-stent-assisted coiling yields high rates of long-term angiographic occlusion, with a relatively low rate of treatmentrelated complications. Y-stent placement with a crossing configuration appears to be associated with better outcomes. Although Y-configuration can be obtained using many types of stents with comparable occlusion rates, the Enterprise stent is associated with lower complication rates.ABBREVIATIONS: IQR ϭ interquartile range; PRISMA ϭ Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SAC ϭ stent-assisted coiling;Y-SAC ϭ Y-stent-assisted coiling W ith the improvement of angiographic imaging, operator experience, and widespread use of more complex techniques, an increased number of intracranial aneurysms can be effectively treated with endovascular techniques. However, aneurysms with wide necks, unfavorable anatomic configurations, and partial incorporation of bifurcation branches are still challenging lesions for endovascular treatment, and each technique presents specific limitations. Balloon-assisted coiling may not be suitable in case of very wide-neck aneu...

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Section: Closed-cell and Open-cell Stentsmentioning

confidence: 99%

Y-Stent-Assisted Coiling of Wide-Neck Bifurcation Intracranial Aneurysms: A Meta-Analysis

Cagnazzo

Limbucci

Nappini

et al. 2018

AJNR Am J Neuroradiol

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“…They represent challenges to clinical understanding and treatment because of their anatomical variations of the Acoma complex. The classifications of Acoma aneurysms in previous studies were based on surgical findings, such as the relationship between the aneurysm projection and the axis defined by the pericallosal artery, 7 the relationship between the aneurysm projection and A2 segment plane, 8 the relationship between the aneurysm projection and A1 segment morphology, 9 and the relationship between the aneurysm and the parent artery. 2,3 The previous classifications of Acoma aneurysms based on intraoperative observations are limited by the differences of their surgical approaches, intraoperative anatomical field, and lack of the standard position leading to the complex and divergent classifications.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Classification of anterior communicating aneurysms on a basis of endovascular treatments

Zhang,

Liang,

Zang

et al. 2023

Neuroradiol J

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Background and purpose The anterior communicating artery (Acoma) aneurysms are difficult to understand because of their anatomical variations. This study reported a new classification of Acoma aneurysms on a basis of endovascular treatments. Methods This retrospective study enrolled consecutive 94 patients harbored 100 Acoma aneurysms treated with coil embolization. All Acoma aneurysms were classified into 5 orientations (straight, superior, inferior, anterior, and posterior) based on the axis connecting A1 origin and the base of the aneurysm. Aneurysm characteristics, endovascular treatments, angiographic, and clinical outcomes were evaluated using this classification. Results According to this classification, there were 64 (64%) straight, 16 (16%) inferior, 16 (16%) superior, 2 (2%) anterior, and 2 (2%) posterior projection aneurysms. There were significant differences between different groups in aneurysm height ( p=0.009) and aneurysm neck size ( p = 0.003), and in endovascular treatments ( p=0.006). There was a significant difference in the proportion of rupture presentation among the three groups of straight, inferior, and superior ( p = 0.019). There was no difference in the results of postoperative angiography ( p = 0.090). An excellent functional outcome with an mRS ≤1 was achieved in 91 (96.8%) patients. Conclusions This classification of Acoma aneurysms based on the axis connecting A1 origin and the base of the aneurysm is associated with aneurysm height, aneurysm neck size, and in need for stent-assisted therapy. Endovascular embolization can provide the same effective treatment for aneurysms in all directions.

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“…In contrast, there have been few reports on its application in the treatment of IC-PC aneurysms. 8,[15][16][17][18] According to a meta-analysis of 27 studies, including 750 aneurysms in 744 patients reported by Cagnazzo et al, the complete occlusion rate by Y-SAC was 95.4%, recanalization rate was 3%, the treatment-related complication rate was 8.9%, the morbidity rate was 2.4%, and the mortality rate was 1.1%. 6) These rate differed among the stents used for Y-SAC; the complete occlusion rate was 96% and the treatment-related complication rate was 6.5% with the Enterprise ( Codman & Shurtleff, Raynham, MA, USA), the complete occlusion rate was 92% and the complication rates was 11% with the LVIS or LVIS Jr (MicroVention, Tustin, CA, USA), and the complication rates were 94% and 14%, respectively, with the Neuroform (Stryker).…”

Section: Discussionmentioning

confidence: 99%

“…Reports about Y-SAC for IC-PC aneurysms are limited, and a total of 12 cases, including four treated by crossing Y-SAC [15][16][17][18] and eight treated by kissing Y-SAC, 8) were found in our review of the relevant literature. The detailed content of treatment was only described in two cases treated by crossing Y-SAC.…”

Section: Discussionmentioning

confidence: 99%

A Case of Coil Embolization with Crossing Y-Configuration Stenting for a Recurrent IC-PC Aneurysm after Clipping

Sato

Kokubo

Kawanami

et al. 2022

JNET

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We report a case in which coil embolization using crossing Y-configuration stenting was effective for an internal carotid-posterior communicating artery (IC-PC) aneurysm with repeated recurrence after clipping. Case Presentation:The patient was a 57-year-old woman. Nine months after undergoing clipping for a ruptured right IC-PC aneurysm at 55 years of age, she developed a second subarachnoid hemorrhage (SAH) due to recurrence of the aneurysm and underwent clipping at the same site. A third SAH due to rupture of the left IC-PC aneurysm developed 1.5 years after the second clipping. Simultaneously, recurrence of a right IC-PC aneurysm was noted and she was referred to our department. The recurrent right IC-PC aneurysm was considered to have originated from the distal to the initial neck. It was 7 mm in size and had an irregularly shaped wide neck. As it was assumed that there would be marked adhesion due to repeated surgery, we decided to treat the aneurysm by coil embolization instead of direct surgery.Although the aneurysm neck partially involved the posterior communicating artery (Pcom), tight packing with a minimal residual neck was required. Therefore, crossing Y-configuration stenting was deployed on the internal carotid artery and Pcom using two Neuroform Atlas stents, and coil embolization was performed by the jail technique. The recurrent aneurysm was obliterated. There were no deficits or thrombotic complications after surgery. On DSA follow-up, no compaction or recurrence was observed, and the Pcom was well visualized one year later. Conclusion:Coil embolization by crossing Y-configuration stenting is a viable treatment option for a recurrent IC-PC wide neck aneurysm.

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Endovascular treatment of wide-neck intracranial bifurcation aneurysms with ‘Y’-configuration, double Neuroform® stents-assisted coiling technique: Experience in a single center

Cited by 19 publications

References 24 publications

Y-Stent-Assisted Coiling of Wide-Neck Bifurcation Intracranial Aneurysms: A Meta-Analysis

Y-Stent-Assisted Coiling of Wide-Neck Bifurcation Intracranial Aneurysms: A Meta-Analysis

Classification of anterior communicating aneurysms on a basis of endovascular treatments

A Case of Coil Embolization with Crossing Y-Configuration Stenting for a Recurrent IC-PC Aneurysm after Clipping

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