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

Abstract

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...

Endovascular treatment of patients with intracranial aneurysms: feasibility and successful employment of a new low profile visible intraluminal support (LVIS) EVO stent

“…However, it is already suggested that the smaller cell size could potentially permit the expansion of a second stent at the intersection point in cases where Y or X-stenting techniques are considered. 26 In addition, we consider this new stent system as a perfect candidate for some alternative stenting techniques such as the 'Flow-T' setting or modified deployment manoeuvres such as the 'railroad switch'. 27,28 On the contrary, there is a certain concern regarding the new LVIS EVO stent observed in our series.…”

Y-Stent-Assisted Coiling With Low-Profile Neuroform Atlas Stents for Endovascular Treatment of Wide-Necked Complex Intracranial Bifurcation Aneurysms

“…A recent metaanalysis that investigated the angiographic outcomes of Y-stentassisted coiling procedures reported an immediate occlusion rate of 82.2%. 25 In a recent study, Ciccio et al 16 observed a relatively lower immediate complete aneurysms occlusion rate of 60% following double stent-assisted coiling with the Neuroform Atlas stent. However, 87.5% of partially coiled aneurysms showed progressive to thrombosis in their case series.…”

“…Two metaanalyses that investigated the outcomes of aneurysms treated with the Y-stent-assisted coiling procedure found that the procedurerelated complication rate was between 8.9% and 12%. 25,26 The open-cell stents were preferred in the first descriptive cases of Y-stenting. The authors reasoned that the open-cell design of the first deployed stent could permit better expansion of the second stent, which was deployed at the interstices of the first stent.…”

“…The follow-up aneurysm occlusion rate in our study is comparable to those reported in previous studies. In a meta-analysis that investigated the outcomes of the Y-stent-assisted coiling, Cagnazzo et al 25 found that the longterm complete or near complete aneurysm occlusion rate was 95.4%. The recurrence risk is significantly lower for aneurysms treated with stent-assisted coiling than in those treated with primary coiling or balloon remodeling techniques.…”

Stent-Assisted Coiling of Unruptured MCA Aneurysms Using the LVIS Jr. Device: A Multicenter Registry

“…However, we have not observed any periprocedural or delayed complications in this subset of patients. A recent meta-analysis by Cagnazzo et al proved that the Y-stenting assisted coiling is an effective treatment for wide-necked intracranial aneurysms with a relatively low rate of treatment related complications [ 18 ]. Table 4 shows aneurysm occlusion rate stratified by number of implanted stents.…”