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Y-configuration double-stent-assisted coiling using two closed-cell stents for wide-neck basilar tip aneurysms

  • Clinical Article - Vascular
  • Published:
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Abstracts

Background

This study aimed to evaluate clinical and angiographic outcomes of Y-configuration double-stent-assisted (Y-stent) coiling using two closed-cell stents for wide-necked basilar tip aneurysm (BTA).

Materials

A total of 25 patients underwent Y-stent coiling using two closed-cell stents as a first-time treatment in 18 (3 ruptured) BTAs, retreatment in 2 BTAs and as a third treatment in 5 wide-necked BTAs. Clinical and angiographic outcomes were evaluated retrospectively.

Results

Treatment-related complications were three (12.0 %) thromboembolic infarctions due to two acute in-stent thromboses and one embolism. Twenty-two (88 %) patients had favorable outcomes (modified Rankin scale score [mRS], 0–2) during the follow-up period (mean, 30 months; range, 6–54 months). Two patients died: one from initial subarachnoid hemorrhage and the other from intracerebral hemorrhage due to underlying Moyamoya disease. Post-treatment angiograms showed complete occlusion in nine aneurysms, residual neck in 11 aneurysms and residual sac in five aneurysms. Follow-up angiograms were available at least once between 5 to 34 months (mean, 16 months) in 21 patients. Nineteen patients showed improved or stable states (complete occlusion, n = 17; residual neck, n = 2). Major recurrences occurred in two BTAs (9.5 %). Those two major recurrent aneurysms had been large-sized aneurysms at the initial coiling procedure. Both showed not only coil compaction but also progressive growth to giant-sized aneurysms and intra-aneurysmal thrombus formation at the Y-stent coiling as a third-time treatment.

Conclusions

Y-stent coiling using two closed-cell stents is a safe and durable treatment option for wide-necked BTA, but may have limited efficacy for large/giant sized and thrombosed aneurysms.

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Conflict of interest

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Authors and Affiliations

  1. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Pyoung Jeon

  2. Department of Radiology, Division of Interventional Neuroradiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seoul, Seodaemun-gu, 120-752, South Korea

    Byung Moon Kim, Dong Joon Kim & Dong I. k Kim

  3. Department of Neurosurgrey, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    Keun Young Park

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  1. Pyoung Jeon
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  2. Byung Moon Kim
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  3. Dong Joon Kim
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  4. Dong I. k Kim
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Corresponding author

Correspondence to Byung Moon Kim.

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Comments

Y- stenting is a well known technique for the treatment of wide necked aneurysms. This technique is mostly performed with at least one open-cell stent because the second stent is deployed through the first. The authors however describe their results of Y-stenting with two closed-cell stents. Major concern in this technique is no optimal opening of the second stent at the crossing of the first. The authors describe the feasibility of this technique and reported follow-up; recanalisation was related to large-sized aneurysm as is usually the casere relatively common and are generally either procedural related or hardware related.

Jeroen Boogaarts

Nijmegen, The Netherlands

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Jeon, P., Kim, B.M., Kim, D.J. et al. Y-configuration double-stent-assisted coiling using two closed-cell stents for wide-neck basilar tip aneurysms. Acta Neurochir 156, 1677–1686 (2014). https://doi.org/10.1007/s00701-014-2163-0

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  • DOI: https://doi.org/10.1007/s00701-014-2163-0

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