title: Crossing Y-stent technique with dual open-cell stents for coiling of wide-necked bifurcation aneurysms.
abstract: OBJECTIVE
  Double stenting in a Y-configuration is a promising therapeutic option for wide-necked cerebral aneurysms not amenable to reconstruction with a single stent. We retrospectively evaluated the efficacy and safety of the crossing Y-stent technique for coiling of wide-necked bifurcation aneurysms.
  
  
  METHODS
  By collecting clinical and radiological data we evaluated from January 2007 through December 2013, 20 wide-necked bifurcation aneurysms.
  
  
  RESULTS
  Twelve unruptured and eight ruptured aneurysms in 20 patients were treated with crossing Y-stent-assisted coiling. Aneurysm size and neck size ranged from 3.2 to 28.2mm (mean 7.5mm) and from 1.9 to 9.1mm (mean 4.5mm). A Y-configuration was established successfully in all 20 patients. All aneurysms were treated with a pair of Neuroform stents. The immediate angiographic results were total occlusion in 17 aneurysms, residual neck in two, and residual sac in one. Peri-operative morbidity was only 5%. Fifteen of 18 surviving patients underwent follow-up conventional angiography (mean, 10.9 months). The result showed stable occlusion in all 15 aneurysms and asymptomatic in-stent occlusion in one branch artery. At the end of the observation period (mean, 33.5 months), all 12 patients without subarachnoid hemorrhage had excellent clinical outcomes (mRS 0), except one (mRS 2). Of eight patients with subarachnoid hemorrhage, four remained symptom free (mRS 0), while the other four had were dependent or dead (mRS score, 3-6).
  
  
  CONCLUSIONS
  In this report on 20 patients, crossing Y-stent technique for coiling of wide-necked bifurcation aneurysms showed a good technical safety and favorable clinical and angiographic outcome.
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Jun Kyeung
authors.initials: JK
authors.lastname: Ko
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: In Ho
authors.initials: IH
authors.lastname: Han
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Cho
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Byung Kwan
authors.initials: BK
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Seung Heon
authors.initials: SH
authors.lastname: Cha
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Chang Hwa
authors.initials: CH
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
authors.forename: Sang Weon
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea. Electronic address: drcello@lycos.co.kr.
authors.forename: Tae Hong
authors.initials: TH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Arterial bifurcation; Coil embolization; Intracranial aneurysm; Y-stent