Y-configuration Stent-assisted Coil Embolization for Wide-necked Intracranial Bifurcation Aneurysms

OBJECTIVE: The objective of this study was to determine the efficiency and safety of Y configuration stent-assisted coiling with double-closed stents for wide-necked intracranial aneurysms located at arterial bifurcations thorough analysis of a multicenter case series. MATERIALS AND METHODS: A retrospective chart review was done on 10 patients who underwent endovascular treatment of wide-necked intracranial aneurysms with Y-configuration stent-assisted coil embolization in three centers from August 2011 to March 2014. The degree of aneurysmal occlusion was assessed using the Raymond scale. Clinical outcomes were assessed before operation, at discharge, and at the last follow-up visit using the Glasgow outcome scale. RESULTS: The 10 patients included 6 females and 4 males with a mean age of 58.6 years. Indications for treatment included 6 unruptured intracranial aneurysms and 4 ruptured intracranial aneurysms. Five aneurysms were located at the basilar artery bifurcation, four aneurysms were located in an anterior communicating artery, and one aneurysm was in the pericallosal artery. The mean size of the 10 aneurysms was 9.7 mm. All aneurysms had a dome-to-neck ratio of < 1.5 (mean, 0.89). Immediate complications included one thromboembolic event out of the 10 cases. Immediate posttreatment angiograms showed complete occlusion in 1 aneurysm and residual necks in 9 aneurysms. Follow-up results showed 8 complete occlusions and 2 residual necks. No delayed complications were observed during the follow-up period (mean: 20 months). CONCLUSION: Y configuration using double-closed cell stents is feasible and safe in selected patients. This method is an acceptable option for managing complex wide-necked bifurcations.

A Ruptured Aneurysm at the Infraoptic Azygous Anterior Cerebral Artery with the Contralateral Internal Carotid Artery Agenesis Treated by Y-stent Assisted Coil Embolization

Infraoptic anterior cerebral artery (ACA) is an extremely rare congenital anomaly. This anomalous artery usually arises from the intradural internal carotid artery (ICA) near the level of the ophthalmic artery (OA) or rarely from the extradural ICA. This anomaly frequently harbors a cerebral aneurysm, and may involve other coexisting vascular anomalies. In the case of this anomaly, surgical treatment of the aneurysm at the proximal ACA or anterior communicating artery (ACoA) may sometimes be difficult, because the veiled proximal ACA by the optic nerve would make proximal control inconvenient and the vertical midline segment of the proximal ACA would frequently form a superiorly directing aneurysm with a relatively high position. We report on an extremely rare case of a ruptured aneurysm at the infraoptic azygous ACA, possibly having an extradural origin, accompanied by contralateral ICA agenesis, and also introduce a feasible method for treatment by Y-stent assisted coil embolization.

Preliminary Results of Y-Stent-Assisted Coil Embolization of Wide-Necked Intracranial Aneurysms: 8 Consecutive Patients / 대한뇌혈관외과학회지

OBJECTIVE: The endovascular treatment of wide-necked intracranial aneurysms is challenging. The stent-assisted coil embolization has facilitated treatment of such complex aneurysms. However, the single stent-assisted technique has a limitation for the wide-necked intracranial aneurysm at the arterial bifurcation. The Y-stent-assisted technique could be an alternative solution for these aneurysms. We present a case series where stent-assisted coil embolization where the Y-configuration stent was used. METHODS: Between January 2007 to December 2010, 8 wide-necked bifurcation aneurysms in 8 patients were treated with the Y-stent technique. Among the eight patients, there were six unruptured aneurysms and the remaining two patients presented with subarachnoid hemorrhage (SAH). Three out of eight aneurysms were located at the anterior communicating artery (ACOM), three at the top of the basilar artery (BA), one at the middle cerebral artery (MCA) bifurcation and one at the pericallosal artery. The size of aneurysm ranged from 3.6 mm to 28.2 mm (mean 8.7 mm, neck size from 3 to 7 mm). Four patients were female and aged ranged from 52 to 73 years. RESULTS: The Y-stent-assisted coil embolization was successfully performed in all 8 cases. The immediate angiographic results were complete occlusion in 7 cases with a remnant neck the remaining case. Angiographic follow-up was done in six patients and stable occlusion was confirmed in all aneurysms. Acute thromboembolism (TE) during the procedure occurred in 4 patients. There were one acute cerebral infarction due to distal coil migration and one delayed cerebral infarction due to in-stent thrombosis after 2 months. CONCLUSION: Traditionally microsurgery has been the treatment of choice for wide-necked intracranial aneurysms at the arterial bifurcation. However, with the advancement of new techniques and instruments for endovascular treatment, the Y-stent-assisted coil embolization seems to be a feasible treatment option for reconstruction of these complex aneurysms.

A Preliminary Study on the Usefullness of a Zilver Stent for Bilateral Stenting in Patients withAdvanced Hilar Cholangiocarcinoma / 대한소화기내시경학회지

BACKGROUND/AIMS: Hilar cholangiocarcinomas have an extremely poor prognosis. Although endoscopic bilateral metal stenting with the "stent in stent" technique using a Y stent is currently employed to treat patients with an unresectable hilar cholangiocarcinoma, this method has limited application in cases of tight strictures. Furthermore, insertion of stents into the Y stent side (first stent side) is problematic in cases of tumor recurrence. We evaluated the clinical efficacy of the use of endoscopic bilateral metal stenting with the Zilver stent. METHODS: Seven patients with an unresectable Bismuth type III or IV hilar cholangiocarcinoma were included in this study. For endoscopic bilateral metal stenting, we first inserted a Y stent with a central wide-open mesh. The Zilver stent was placed into the contralateral hepatic duct through the central portion of the Y stent. RESULTS: Both technical and functional success was achieved in seven patients (100%). The early complication rate was 0%, and late complications due to tumor recurrence occurred in 2 out of 7 (28.6%) patients. These patients were managed by the placement of additional stents or with the use of percutaneous transhepatic biliary drainage. CONCLUSIONS: We suggest that a combination technique using Y and Zilver stents improves bilateral stenting for patients with advanced hilar cholangiocarcinoma and facilitates stent reinsertion in cases of tumor recurrence.