title: Y-Stent embolization technique for intracranial bifurcation aneurysms.
abstract: Wide-necked bifurcation aneurysms often require the use of the technically complex Y-stent technique, which has recently been shown to narrow bifurcation angle in a hemodynamically favorable manner. We sought to evaluate the single center efficacy and safety of Y-stent supported aneurysm coil embolization. All patients undergoing Y-stent supported coiling between September 2006 and December 2012 were identified; records were analyzed for procedural results and complications, with follow-up evaluated for occlusion rate and neurological adverse events. Twenty consecutive patients underwent technically successful Y-stent supported coiling, with complete aneurysm occlusion achieved in 19/20 cases (95%). There were no peri-procedural clinically evident neurological complications following Y-stenting. Clinical follow-up was available for a mean of 20.0months and radiographic follow-up was available for a mean of 18.5months. During the follow-up period, three patients (15%) required re-treatment with through-stent coiling for recanalization. At latest follow-up, Raymond grade I occlusion was achieved in 16 patients (80%), Raymond grade II occlusion achieved in four patients (20%) and Raymond grade III occlusion in zero patients. Y-stenting for complex intracranial aneurysms appears effective in achieving durable aneurysm occlusion with an acceptable safety profile. Though the procedure is technically more complex than single-stent procedures, the Y-stent configuration should be considered when single-stent supported coiling is not feasible or sufficient.
authors.affiliation: Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Heller
authors.affiliation: Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, USA.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Rahal
authors.affiliation: Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, USA. Electronic address: amalek@tuftsmedicalcenter.org.
authors.forename: Adel M
authors.initials: AM
authors.lastname: Malek
mesh_terms: D015901:Angiography, Digital Subtraction; D001488:Basilar Artery; D002343:Carotid Artery, Internal; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery; D019233:Retreatment; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
keywords: Adjunctive technique; Aneurysm; Endovascular treatment; Y-stent