Y Stent-Assisted Coiling Technique for Bifurcation Aneurysms Using Double Neuroform® Stent: a Large Restrospective Series.

BACKGROUND: Stent assisted coiling technique have shown to be an effective and safe endovascular strategy for wide neck bifurcation aneurysms in achieving greater packing, allowing the closure of the aneurysm and preserving the parent arteries, compared to simple coiling. MATERIAL AND METHODS: We conducted a retrospective analysis of 79 patients with cerebral aneurysms treated using 'Y'-configuration double Neuroform® stent-assisted coiling at our center from July 2009 to July 2022. RESULTS: Of the 79 patients, 76% (60/79) were incidental unruptured cerebral aneurysm and 24% were patients treated for aneurysm recanalization of a previous ruptured aneurysm (19/79). The most frequent locations were anterior communicating artery (AComA) 44.3% (35/79) and middle cerebral artery (MCA) 32.9% (26/79). We found a complete and almost complete aneurysm occlusion (Raymond-Roy occlusion classification (RROC) 1 and 2): in 100% (79/79) in the angiography after procedure, in 97.6% (42/43) at the first follow-up at 6-8 months and 100% (57/57) at the first 1-2 years of follow-up. No mortality related to treatment was detected. We registered 2.5% (2/79) major ipsilateral strokes, one due to acute in stent thrombosis (patient had a mRS: 0 in follow up at 90 days) and a spinal anterior artery occlusion (patient had a mRS: 3 in follow up at 90 days). CONCLUSION: The 'Y' stent-assisted coiling technique with double Neuroform® is a safe and effective technique for the treatment of wide-neck bifurcation aneurysms, with high rates of complete occlusion, preserving the permeability of the afferent and efferent arteries and low rate of complications.

New devices for interventional therapy of intracranial aneurysms: endosaccular flow diverters / 中华神经医学杂志

Endosaccular flow diverter is a new endovascular device of treating intracranial wide neck bifurcation aneurysms. Four kinds of endosaccular flow diverters with different shapes and features have been produced and implanted into the intracranial aneurysms. This article provides a review on the features and clinical use of these new devices.

Efficacy of double low-profile visualized intraluminal support stent assisted embolization in treatment of acute intracranial wide-neck aneurysms and its relation with levels of soluble intercellular adhesion molecule-1 and S100B / 中华神经医学杂志

Objective To explore the efficacy of double low-profile visualized intraluminal support (LVIS) stent assisted embolization in the treatment of acute intracranial wide-neck aneurysms and its relation with levels of soluble intercellular adhesion molecule-1 (SICAM-1) and S100B. Methods A total of 114 patients with acute intracranial wide-neck aneurysms admitted to our hospital from June 2014 to December 2018 were collected. According to different treatment options, the patients in the study group (n=58) were treated with double LVIS stent-assisted embolization, while those in the control group (n=56) were treated with LVIS stent-assisted embolization. The embolization degrees of intracranial wide-necked aneurysms were evaluated by Raymond grading immediately after surgery, the efficacy of the patients was evaluated by modified Rankin scale (mRS) at discharge, and the serum SICAM-1 and S100B protein levels of the patients with different treatment methods and different curative effects before and after surgery were compared. Results As compared with those in the control group, the degrees of arterial embolization immediately after surgery and good therapeutic effect rate at discharge were significantly higher in the study group (P<0.05). After treatment, the serum levels of SICAM-1 and S100B were significantly lower in the study group than those in the control group (P<0.05). The levels of SICAM-1 and S100B in patients with good therapeutic effect ([147.5±9.8] mg/mL and [0.106±0.027] mg/mL) were significantly lower than those in the patients with poor therapeutic effect ([172.8 ±4.0] mg/mL and [0.158±0.002] mg/mL, P<0.05). Conclusions The embolization rate and therapeutic effect can be significantly improved in patients with acute intracranial wide-neck aneurysms after double-LVIS stent-assisted embolization. The serum levels of SICAM-1 and S100B are significantly increased in patients with poor therapeutic effect.

Planned Stage Endovascular Treatment for Complex Wide Neck Aneurysm

Treatment of a complex, wide neck aneurysm sometimes cannot be achieved in a single endovascular session. This case illustrates a planned stage endovascular treatment of a complex aneurysm with remodeling technique aiming to eliminate risk of rebleeding during acute phase in the first stage of treatment, and complete occlusion in the second stage of treatment. After first stage, separation between coil mass and neck remnant was clearly shown indicating presence of neointimal layer. Multiple sessions also provide proper planning and more controlled treatment of difficult aneurysms.

Staged Y-shaped Stent Assisted Coil Embolization in a Wide-Neck Basilar Tip Aneurysm: Case Report / 신경중재치료의학

A 67-year-old male presented with a subarachnoid hemorrhage and was found to have a basilar artery (BA) tip aneurysm, which was incorporated to both posterior cerebral arteries (PCAs). First, he was treated with the single stent, which was deployed from P1 segment of the right PCA to BA, and coil embolization was done. Follow-up angiogram at 18 months revealed coil compaction of the aneurysm. Therefore, we accomplished the Y-configured dual stent assisted coil embolization. Follow-up angiogram at 30 months revealed no recanalization of aneurysm and patent blood flow of both PCAs. In conclusion, staged Y-shaped stents assisted coil embolization is an alternative treatment option in a wide-neck basilar tip aneurysm decreasing the extent of coil compaction of aneurysm and preserving an incorporated vessel.