Limbucci Nicola, Renieri Leonardo, Nappini Sergio, Consoli Arturo, Rosi Andrea, Mangiafico Salvatore
Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy.
J Neurointerv Surg. 2016 Feb;8(2):158-62. doi: 10.1136/neurintsurg-2014-011483. Epub 2014 Dec 11.
Y-stent assisted coiling has been proposed for the treatment of wide-neck bifurcation aneurysms, but there are many technical variations. We report our single-center experience of Y-stent assisted coiling of bifurcation aneurysms with the closed cell Enterprise stent in order to evaluate the safety and long-term results of this technique. The literature on Y-stenting and its hemodynamic effects are reviewed.
Fifty-two consecutive patients with wide-neck bifurcation aneurysms underwent Y-stent assisted coiling with two Enterprise stents. The procedure was completed in 48 cases (92.3%) and technical failure occurred in 4 cases (7.3%). Cases performed with other stents were excluded. All procedures were performed under double antiplatelet therapy. Periodic clinical and neuroradiological follow-up was performed.
Mean neuroradiological follow-up time was 26 months. Complete immediate occlusion was obtained in 87.5% of patients. Two remnants had regrown at follow-up and were recoiled, achieving complete occlusion. The late neuroradiological occlusion rate was: complete occlusion 93.6%, neck remnant 4.3%, sac remnant 2.1%. No in-stent stenosis was detected at follow-up. Among the 48 procedures, two complications occurred (4.2%). Mortality was 2.1%. No delayed ischemic stroke occurred.
Y-stent assisted coiling has a high immediate occlusion rate and very good long-term stability. The procedure is relatively safe, although the complication and mortality rates are not negligible. Two Enterprise stents can be safely used for Y-stenting and, indeed, offer the advantage of easier catheterization, delivery and deployment into distal and tortuous vessels than open cell stents.
Y型支架辅助弹簧圈栓塞术已被用于治疗宽颈分叉动脉瘤，但存在多种技术变体。我们报告了我们使用闭合式Enterprise支架对分叉动脉瘤进行Y型支架辅助弹簧圈栓塞术的单中心经验，以评估该技术的安全性和长期效果。同时对Y型支架置入及其血流动力学效应的相关文献进行了综述。
连续52例宽颈分叉动脉瘤患者接受了使用两枚Enterprise支架的Y型支架辅助弹簧圈栓塞术。48例（92.3%）手术成功完成，4例（7.3%）出现技术失败。排除使用其他支架的病例。所有手术均在双重抗血小板治疗下进行。进行定期的临床和神经放射学随访。
平均神经放射学随访时间为26个月。87.5%的患者实现了即刻完全栓塞。随访时有2处残余瘤体复发并再次进行了弹簧圈栓塞，最终实现完全栓塞。晚期神经放射学栓塞率为：完全栓塞93.6%，瘤颈残余4.3%，瘤囊残余2.1%。随访时未检测到支架内狭窄。在48例手术中，发生了2例并发症（4.2%）。死亡率为2.1%。未发生延迟性缺血性卒中。
Y型支架辅助弹簧圈栓塞术具有较高的即刻栓塞率和非常好的长期稳定性。该手术相对安全，尽管并发症和死亡率并非可以忽略不计。两枚Enterprise支架可安全用于Y型支架置入，实际上，与开放式支架相比，其在导管插入、输送以及部署到远端和迂曲血管方面具有更容易的优势。
