A Multicenter Study of Stent-Assisted Coiling of Cerebral Aneurysms With a Y Configuration

作者：Fargen Kyle M^*; Mocco J; Neal Dan; Dewan Michael C; Reavey Cantwell John; Woo Henry H; Fiorella David J; Mokin Maxim; Siddiqui Adnan H; Turk Aquilla S; Turner Raymond D; Chaudry Imran; Kalani M Yashar S; Albuquerque Felipe; Hoh Brian L

来源：Neurosurgery, 2013, 73(3): 466-472.

DOI：10.1227/NEU.0000000000000015

• Cerebral aneurysm
• Coiling
• Endovascular
• Stent
• Y stent

BACKGROUND: Stent-assisted coiling with 2 stents in a Y configuration is a technique for coiling complex wide-neck bifurcation aneurysms. %26lt;br%26gt;OBJECTIVE: We sought to provide long-term clinical and angiographic outcomes with Y-stent coiling, which are not currently established. %26lt;br%26gt;METHODS: Seven centers provided deidentified, retrospective data on all consecutive patients who underwent stent-assisted coiling for an intracranial aneurysm with a Y-stent configuration. %26lt;br%26gt;RESULTS: Forty-five patients underwent treatment by Y-stent coiling. Their mean age was 57.9 years. Most aneurysms were basilar apex (87%), and 89% of aneurysms were unruptured. Mean size was 9.9 mm. Most aneurysms were treated with 1 open-cell and 1 closed-cell stent (51%), with 29% treated with open-open stents and 16% treated with 2 closed-cell stents. 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 1 patient progressed to a better occlusion grade (83%; P %26lt; .05). Three aneurysms required retreatment because of recanalization (10%). There was no difference in initial or follow-up angiographic occlusion, clinical outcomes, incidence of aneurysm retreatment, or in-stent stenosis among open-open, open-closed, or closed-closed stent groups. %26lt;br%26gt;CONCLUSION: In a large multicenter series of Y-stent coiling for bifurcation aneurysms, there were low complication rates and excellent clinical and angiographic outcomes.

• 出版日期2013-9