Akgul Erol, Balli Tugsan, Aksungur Erol H
Radiology Department, Medical Faculty, Cukurova University, Adana, Turkey
Radiology Department, Medical Faculty, Cukurova University, Adana, Turkey.
Interv Neuroradiol. 2015 Feb;21(1):29-39. doi: 10.1177/1591019915575436.
In Y-stenting, stabilization of the first stent may be problematic as in some cases it migrates during second stent insertion. This report evaluates the safety and effectiveness of the technique and presents the long-term results of hybrid, Y-configured, dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms. We retrospectively evaluated the patients treated endovascularly due to cerebral aneurysms. Twenty patients treated with hybrid Y-stent-assisted coil embolization were enrolled in the study. In hybrid stenting, an open-cell intracranial stent (Neuroform) was used as a first stent to prevent stent migration. A closed-cell stent (Enterprise or Acclino) was used as a second stent and the aneurysm was embolized with coils between the stent struts. In all patients, hybrid Y-stenting and coil embolization were accomplished successfully. No stent migration occurred. Clinically, neither symptomatic neurologic complication nor death was seen. Of 20 wide-necked bifurcation aneurysms, nine were at the basilar tip, while seven were at the middle cerebral artery and three at the anterior communicating artery. In one patient, the aneurysm was at the A2-3 junction of the anterior cerebral artery. One of the patients had a subarachnoid hemorrhage. The mean angiographic follow-up was 25.6 months. No in-stent stenosis was seen in any of the patients and recanalization in only one. Hybrid, Y-configured, dual stent-assisted coil embolization is a safe and effective method in the treatment of wide-necked bifurcation aneurysms to prevent stent migration and aneurysm recanalization, and is a viable alternative to microsurgery.
在Y形支架置入术中，首个支架的稳定性可能存在问题，因为在某些情况下，它会在置入第二个支架时发生移位。本报告评估了该技术的安全性和有效性，并展示了混合式、Y形配置、双支架辅助弹簧圈栓塞术治疗宽颈分叉动脉瘤的长期结果。我们回顾性评估了因脑动脉瘤接受血管内治疗的患者。20例接受混合Y形支架辅助弹簧圈栓塞术治疗的患者纳入本研究。在混合支架置入术中，使用开放式颅内支架（Neuroform）作为首个支架以防止支架移位。使用闭合式支架（Enterprise或Acclino）作为第二个支架，并在支架小梁之间用弹簧圈栓塞动脉瘤。所有患者均成功完成混合Y形支架置入术和弹簧圈栓塞术。未发生支架移位。临床上，未观察到有症状的神经并发症或死亡。在20个宽颈分叉动脉瘤中，9个位于基底动脉尖，7个位于大脑中动脉，3个位于前交通动脉。1例患者的动脉瘤位于大脑前动脉A2-3交界处。其中1例患者有蛛网膜下腔出血。血管造影平均随访时间为25.6个月。所有患者均未出现支架内狭窄，仅1例出现再通。混合式、Y形配置、双支架辅助弹簧圈栓塞术是治疗宽颈分叉动脉瘤以防止支架移位和动脉瘤再通的一种安全有效的方法，是显微手术的可行替代方案。
