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

Fargen, Kyle M. MD, MPH*; Mocco, J MD, MS; Neal, Dan MS*; Dewan, Michael C. MD; Reavey-Cantwell, John MD, MS§; Woo, Henry H. MD; Fiorella, David J. MD; Mokin, Maxim MD, PhD; Siddiqui, Adnan H. MD, PhD||; Turk, Aquilla S. DO#; Turner, Raymond D. MD#; Chaudry, Imran MD#; Kalani, M. Yashar S. MD, PhD**; Albuquerque, Felipe MD**; Hoh, Brian L. MD*

doi: 10.1227/NEU.0000000000000015
Research-Human-Clinical Studies: Editor's Choice
Editor's Choice

BACKGROUND: Stent-assisted coiling with 2 stents in a Y configuration is a technique for coiling complex wide-neck bifurcation aneurysms.

OBJECTIVE: We sought to provide long-term clinical and angiographic outcomes with Y-stent coiling, which are not currently established.

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.

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 < .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.

CONCLUSION: In a large multicenter series of Y-stent coiling for bifurcation aneurysms, there were low complication rates and excellent clinical and angiographic outcomes.

ABBREVIATION: mRS, modified Rankin Scale

*Department of Neurosurgery, University of Florida, Gainesville, Florida;

Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee;

§Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia;

Departments of Neurosurgery and Radiology, Stony Brook University Medical Center, Stony Brook, New York;

Department of Neurosurgery, University at Buffalo, Buffalo, New York;

#Departments of Neurosurgery and Radiology, Medical University of South Carolina, Charleston, South Carolina;

**Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona

Correspondence: Kyle M. Fargen, MD, MPH, Box 100265, Gainesville, FL 32610. E-mail:

Received December 13, 2012

Accepted May 30, 2013

Copyright © by the Congress of Neurological Surgeons