Low complication rates and good clinical outcome with Y-stent coiling for bifurcation aneurysms

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A retrospective, multicentre series, published in Neurosurgery in September, demonstrates that stent-assisted coiling with two stents in a Y configuration has a low rate of complications, a low incidence of re-treatment and in-stent stenosis. Good outcome was obtained in 93% of patients at the last follow-up.

Kyle M Fargen, Department of Neurosurgery, University of Florida, Gainesville, USA, and colleagues set out to provide long-term clinical and angiographic outcomes (that are currently unascertained) with Y-stent coiling, which is a technique that is used to coil complex wide-neck bifurcation aneurysms.

The researchers obtained retrospective data on all consecutive patients who underwent stent-assisted coiling for an intracranial aneurysm with a Y-stent configuration from seven centres.

The investigators found that 45 patients (mean age 57.9 years) underwent treatment by Y-stent coiling. The majority (87%) of aneurysms were basilar apex, and 89% were unruptured. Mean aneurysm size was 9.9mm. Most aneurysms were treated with one open-cell and one closed-cell stent (51%), with 29% treated with open-open stents and 16% treated with two closed-cell stents.

The results of the study showed that initial aneurysm occlusion was excellent (84% in Raymond grade I or II). Procedural complications occurred in 11% of patients. Mean clinical follow-up was 7.8 months, and 93% of patients had a modified Rankin Scale score of 0 to 2 at last follow-up. Mean angiographic follow-up was 9.8 months, and 92% of patients had Raymond grade I or II occlusion on follow-up imaging. “Of those patients with initial Raymond grade III occlusion and follow-up imaging, all but one patient progressed to a better occlusion grade. Three aneurysms required re-treatment because of recanalisation (10%). There were no significant differences in angiographic occlusion, retreatment, or patient outcomes based on the type of stents used,” the authors wrote.

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