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Y-configuration double-stent-assisted coiling using two closed-cell stents for wide-neck basilar tip aneurysms

 Pyoung Jeon  ;  Byung Moon Kim  ;  Dong Joon Kim  ;  Dong I. k Kim  ;  Keun Young Park 
 ACTA NEUROCHIRURGICA, Vol.156(9) : 1677-1686, 2014 
Journal Title
Issue Date
Adult ; Aged ; Aneurysm, Ruptured/diagnostic imaging ; Aneurysm, Ruptured/therapy* ; Cerebral Angiography ; Disability Evaluation ; Embolization, Therapeutic/adverse effects ; Embolization, Therapeutic/instrumentation* ; Equipment Design ; Female ; Humans ; Image Interpretation, Computer-Assisted ; Imaging, Three-Dimensional ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/therapy* ; Male ; Middle Aged ; Recurrence ; Retreatment ; Retrospective Studies ; Stents*
Aneurysm ; Basilar artery ; Coiling ; Stent-assistance
BACKGROUND: This study aimed to evaluate clinical and angiographic outcomes of Y-configuration double-stent-assisted (Y-stent) coiling using two closed-cell stents for wide-necked basilar tip aneurysm (BTA).
MATERIALS: A total of 25 patients underwent Y-stent coiling using two closed-cell stents as a first-time treatment in 18 (3 ruptured) BTAs, retreatment in 2 BTAs and as a third treatment in 5 wide-necked BTAs. Clinical and angiographic outcomes were evaluated retrospectively.
RESULTS: Treatment-related complications were three (12.0 %) thromboembolic infarctions due to two acute in-stent thromboses and one embolism. Twenty-two (88 %) patients had favorable outcomes (modified Rankin scale score [mRS], 0-2) during the follow-up period (mean, 30 months; range, 6-54 months). Two patients died: one from initial subarachnoid hemorrhage and the other from intracerebral hemorrhage due to underlying Moyamoya disease. Post-treatment angiograms showed complete occlusion in nine aneurysms, residual neck in 11 aneurysms and residual sac in five aneurysms. Follow-up angiograms were available at least once between 5 to 34 months (mean, 16 months) in 21 patients. Nineteen patients showed improved or stable states (complete occlusion, n = 17; residual neck, n = 2). Major recurrences occurred in two BTAs (9.5 %). Those two major recurrent aneurysms had been large-sized aneurysms at the initial coiling procedure. Both showed not only coil compaction but also progressive growth to giant-sized aneurysms and intra-aneurysmal thrombus formation at the Y-stent coiling as a third-time treatment.
CONCLUSIONS: Y-stent coiling using two closed-cell stents is a safe and durable treatment option for wide-necked BTA, but may have limited efficacy for large/giant sized and thrombosed aneurysms.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Park, Keun Young(박근영)
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