Double Stent–Assisted Coil Embolization Treatment for Bifurcation Aneurysms: Immediate Treatment Results and Long-Term Angiographic Outcome

Abstract

BACKGROUND AND PURPOSE:The goal of endovascular treatment of cerebral bifurcation aneurysms is to achieve safe coiling of the sac along with preserving patency of the diverging branches. Our purpose was evaluate procedural safety and efficacy as well as the long-term durability of endovascular treatment of bifurcation aneurysms with double stent-assisted coiling.

Endovascular Treatment of Middle Cerebral Artery Aneurysms with Flow Modification with the Use of the Pipeline Embolization Device

“…With the introduction of the Y-stent placement technique with or without endosaccular coiling, 8,26,27 many of these difficult aneurysms have become amenable to treatment while preserving the parent arteries. However, in cases in which the branch has an acute angle relative to the main trunk, intra-aneurysmal maneuvers as well as exchange procedures are necessitated to catheterize this branch, increasing the risk of procedural hemorrhagic complications caused by aneurysmal rupture and wire perforation.…”

“Y” and “X” Stent-Assisted Coiling of Complex and Wide-Neck Intracranial Bifurcation Aneurysms

“…In this series, most were basilar tip aneurysms (87%), a location where the navigation and the deployment of stents are easier due to favorable distal limb configuration. In a large retrospective series 24 consisting of 193 bifurcation aneurysms, by using mostly closed-cell stents, the authors reported a low rate of permanent morbidity (1.1%) and mortality (0.5%). Although we also applied a strict antiaggregation protocol and checked 1 week before the procedure, our hemorrhagic and ischemic complications led to a higher rate of permanent morbidity.…”

“…[16][17][18][19][20][21][22][23] Recently, the efficacy, feasibility, and long-term durability were described in a large retrospective series. 24 Although several concerns remain regarding stent combinations and the rate of neurologic complications, in our institution since 2006, we have been using this technique with different stent combinations to treat complex and wide-neck bifurcation intracranial aneurysms. Our purpose is to present our experience with double stents in X and Y configurations, with an emphasis on safety, feasibility, and efficacy.…”

Hybrid Y Stenting with the Waffle-Cone

“…In our small series we did not observe any ischaemic event, although the number of patients is too small to assess this point. The same risk occurs with Y stent-assisted coiling, but in the largest series of aneurysms treated with this technique the ischaemic complication rate was low 7,8 .…”