Heller Robert S, Rahal Jason P, Malek Adel M
Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, USA.
Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, USA.
J Clin Neurosci. 2014 Aug;21(8):1368-72. doi: 10.1016/j.jocn.2013.11.028. Epub 2014 May 3.
Wide-necked bifurcation aneurysms often require the use of the technically complex Y-stent technique, which has recently been shown to narrow bifurcation angle in a hemodynamically favorable manner. We sought to evaluate the single center efficacy and safety of Y-stent supported aneurysm coil embolization. All patients undergoing Y-stent supported coiling between September 2006 and December 2012 were identified; records were analyzed for procedural results and complications, with follow-up evaluated for occlusion rate and neurological adverse events. Twenty consecutive patients underwent technically successful Y-stent supported coiling, with complete aneurysm occlusion achieved in 19/20 cases (95%). There were no peri-procedural clinically evident neurological complications following Y-stenting. Clinical follow-up was available for a mean of 20.0months and radiographic follow-up was available for a mean of 18.5months. During the follow-up period, three patients (15%) required re-treatment with through-stent coiling for recanalization. At latest follow-up, Raymond grade I occlusion was achieved in 16 patients (80%), Raymond grade II occlusion achieved in four patients (20%) and Raymond grade III occlusion in zero patients. Y-stenting for complex intracranial aneurysms appears effective in achieving durable aneurysm occlusion with an acceptable safety profile. Though the procedure is technically more complex than single-stent procedures, the Y-stent configuration should be considered when single-stent supported coiling is not feasible or sufficient.
宽颈分叉动脉瘤通常需要采用技术复杂的Y型支架技术，最近的研究表明，该技术能以血流动力学上有利的方式缩小分叉角度。我们旨在评估Y型支架辅助动脉瘤弹簧圈栓塞术在单中心的有效性和安全性。确定了2006年9月至2012年12月期间所有接受Y型支架辅助弹簧圈栓塞术的患者；分析记录以了解手术结果和并发症，并评估随访中的闭塞率和神经学不良事件。连续20例患者接受了技术上成功的Y型支架辅助弹簧圈栓塞术，19/20例（95%）实现了动脉瘤完全闭塞。Y型支架置入术后没有出现围手术期明显的神经学并发症。临床随访平均时间为20.0个月，影像学随访平均时间为18.5个月。在随访期间，3例患者（15%）因再通需要通过支架弹簧圈栓塞进行再次治疗。在最近一次随访时，16例患者（80%）达到Raymond I级闭塞，4例患者（20%）达到Raymond II级闭塞，0例患者达到Raymond III级闭塞。Y型支架置入术治疗复杂颅内动脉瘤似乎能有效实现持久的动脉瘤闭塞，且安全性可接受。尽管该手术在技术上比单支架手术更复杂，但当单支架辅助弹簧圈栓塞不可行或不充分时，应考虑使用Y型支架构型。
