RT Journal Article
SR Electronic
T1 Y-Stent-Assisted Coiling of Wide-Neck Bifurcation Intracranial Aneurysms: A Meta-Analysis
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 122
OP 128
DO 10.3174/ajnr.A5900
VO 40
IS 1
A1 F. Cagnazzo
A1 N. Limbucci
A1 S. Nappini
A1 L. Renieri
A1 A. Rosi
A1 A. Laiso
A1 D. Tiziano di Carlo
A1 P. Perrini
A1 S. Mangiafico
YR 2019
UL http://www.ajnr.org/content/40/1/122.abstract
AB 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%; I2 = 92%), whereas the long-term complete/near-complete occlusion rate was 95.4% (564/598; 95% CI, 93.7%–97%; I2 = 0%) (mean radiologic follow-up of 14 months). The aneurysm recanalization rate was 3% (20/496; 95% CI, 1.5%–4.5%; I2 = 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%; I2 = 44%). Morbidity and mortality after treatment were 2.4% (18/540; 95% CI, 1.2%–3.7%; I2 = 0%) and 1.1% (5/668; 95% CI, 0.3%–1.9%; I2 = 0%), respectively. Crossing Y-stent placement was associated with a slightly lower complication rate compared with the kissing configuration (56/572 = 8.4%; 95% CI, 5%–11%; I2 = 46% versus 4/30 = 12.7%; 95% CI, 3%–24%; I2 = 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 = 6.5%; 95% CI, 1.6%–11%; I2 = 0%) compared with the others (20/131 = 14%; 95% CI, 5%–26%; I2 = 69% and 9/64 = 11%; 95% CI, 3%–20%; I2 = 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 treatment-related 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.IQRinterquartile rangePRISMAPreferred Reporting Items for Systematic Reviews and Meta-AnalysesSACstent-assisted coilingY-SACY-stent-assisted coiling