stent-assisted coiling

INTRODUCTION: Stenting with a Y-configuration is an endovascular option for repairing wide-neck aneurysms spanning vascular bifurcations. Most reports focus on basilar tip aneurysms. We report mid-term results for the largest series of Y-stenting in the anterior circulation. METHODS: Retrospective review of anterior circulation aneurysms treated with Y-stenting at Rush University Medical Center between 2004 and 2011. RESULTS: Fourteen patients met inclusion criteria. Ten middle cerebral artery (MCA) aneurysms were treated: 4/10 Raymond 1 post-treatment; 6/6 Raymond 1 at follow-up. Two internal carotid artery (ICA) aneurysms were Raymond 3 initially; 1/1 Raymond 1 at follow-up. One ICA aneurysm had a peri-procedural mortality. Two anterior communicating artery (Acomm) aneurysms were treated: 1/2 Raymond 1, 1/2 Raymond 3; neither changed at follow-up. In total, 93 % of anterior circulation aneurysms had Raymond 1 occlusion at follow-up. The single aneurysm that did not achieve Raymond 1 occlusion failed clipping prior to Y-stenting and did not undergo coiling. CONCLUSION: Y-stenting is an effective option for treatment of wide-neck bifurcation aneurysms in the anterior circulation. A number of aneurysms initially had evidence of residual neck or aneurysmal sac but in nearly all cases follow-up angiography revealed Raymond 1 occlusion. The overall risk of Y-stenting remains a concern. We did not encounter any serious complications in treating MCA and Acomm aneurysms; however, 1 death in this series occurred in an ICA aneurysm. In summary, the Y-stenting technique is very effective for aneurysm treatment, but the safety remains uncertain.