title: Midterm results of T-stent-assisted coiling of wide-necked and complex intracranial bifurcation aneurysms using low-profile stents.
abstract: OBJECTIVE Coiling of wide-necked and complex bifurcation aneurysms frequently requires implantation of double stents in various configurations. T-stent-assisted coiling involves the nonoverlapping implantation of 2 stents to protect the daughter vessels of bifurcation and is followed by coiling of the aneurysm. The authors studied the feasibility, efficacy, and safety of the T-stent-assisted coiling procedure as well as the midterm angiographic/clinical outcomes of patients with wide-necked bifurcation intracranial aneurysms treated using this technique. METHODS The authors retrospectively identified patients with wide-necked bifurcation intracranial aneurysms treated using double-stent-assisted coiling with a T-stent configuration. RESULTS Twenty-four patients with 24 aneurysms and a mean of age of 51.91 years were identified. The most common locations were the middle cerebral bifurcation (45.8%) and anterior communicating artery (35.7%). T stentings were performed using low-profile stents. The procedures were performed with a technical success rate of 95.8%, and an immediate total occlusion rate of 79.2% was achieved. We observed periprocedural complications in 16.7% of cases and a delayed thromboembolic event in 4.2%. The complications caused permanent morbidity in 1 patient (4.2%). No deaths occurred. The mean angiographic follow-up duration was 9.3 months. The total occlusion rate at the last follow-up was 81.2%. The recanalization rate was 4.5%. Modified Rankin Scale scores of all patients at the last follow-ups were between zero and 2. CONCLUSIONS T-stent-assisted coiling using low-profile stents is a feasible, effective, and relatively safe endovascular technique used to treat wide-necked and complex intracranial aneurysms. The midterm angiographic and clinical outcomes are outstanding.
authors.affiliation: 1Department of Radiology, Neuroradiology Division, and.|2Department of Radiology, Koc University Hospital, Topkapi, Istanbul, Turkey; and.
authors.forename: Kubilay
authors.initials: K
authors.lastname: Aydin
authors.affiliation: 1Department of Radiology, Neuroradiology Division, and.
authors.forename: Serra
authors.initials: S
authors.lastname: Sencer
authors.affiliation: 1Department of Radiology, Neuroradiology Division, and.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Barburoglu
authors.affiliation: 3Department of Neurosurgery, Presidential Hospital, Almaty City, Kazakhstan.
authors.forename: Mynzhylky
authors.initials: M
authors.lastname: Berdikhojayev
authors.affiliation: 4Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Capa.
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Aras
authors.affiliation: 4Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Capa.
authors.forename: Altay
authors.initials: A
authors.lastname: Sencer
authors.affiliation: 4Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Capa.
authors.forename: Nail
authors.initials: N
authors.lastname: İzgi
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: ACoA = anterior communicating artery; DSA = digital subtraction angiography; MCA = middle cerebral artery; aPTT = activated partial thromboplastin time; endovascular; intracranial aneurysm; mRS = modified Rankin Scale; stent-assisted coiling; vascular disorders; wide-necked