J Cerebrovasc Endovasc Neurosurg.  2022 Mar;24(1):1-9. 10.7461/jcen.2021.E2021.06.010.

Y-stent-assisted coiling with Neuroform Atlas stents for wide-necked intracranial bifurcation aneurysms: A preliminary report

• Kim D
• Chung J

• KMID: 2527589
• DOI: http://doi.org/10.7461/jcen.2021.E2021.06.010

Abstract

Objective
To report our experience on Neuroform Atlas Y-stenting for coiling of unruptured wide-neck bifurcation aneurysms.
Methods
From March 2018 to January 2021, we treated 473 aneurysms in 436 patients with coil embolization, of which 15 cases with wide-necked bifurcation aneurysms were treated by Y-stent-assisted coiling with two Neuroform Atlas stents. We retrospectively reviewed the characteristics of patients and aneurysms, procedure-related complications, radiographic results, and clinical outcomes.
Results
All 15 cases using Neuroform Atlas Y-stenting were successful. Patients included 6 men and 9 women with a mean age ± standard deviation of 56.4±6.6 years. The mean dome and neck sizes were 6.4±3.1 mm and 4.7±1.8 mm, respectively. Immediate post-procedural angiograms showed complete occlusion in 46.7%, neck remnant in 13.3%, and incomplete occlusion in 40% of cases. No treatment-related morbidity or mortality occurred in any patients. All patients had good clinical outcomes (Glasgow Outcome Score 5) at both discharge and during a mean 12.3-month (range 1-28 months) follow-up. All aneurysms showed improved or stable occlusion on follow-up imaging. Further, the latest follow-up angiography showed complete occlusion in 73.3%, neck remnant in 6.7%, and incomplete occlusion in 20%.
Conclusions
Y-stent-assisted coiling with Neuroform Atlas stents might be a feasible and safe option for wide-necked bifurcation aneurysms.

Keyword

Endovascular procedures; Intracranial aneurysm; Stents

Figure

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  Fig. 1. (A) Cerebral angiography demonstrating a wide-necked (3.81 mm) anterior communicating aneurysm. (B) 3-dimensional aneurysm reconstruction. The superior hypophyseal aneurysm is also shown. (C) Post-procedural angiography after stent-assisted coiling of the two aneurysms shows delayed flow of the right A2 (black head arrows) due to thrombosis. (D) Microcatheter navigated from left ACA to right A2 through previous stents by cell-through techniques. (E) Y-stenting technique performed via double Neuroform Atlas stents (black head arrows). (F) Final angiography image revealing recanalization of right cerebral anterior artery (black head arrows). (G, H) 12-month follow up angiography image showing complete occlusion of both aneurysms without in-stent stenosis. ACA, anterior cerebral artery.

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  Fig. 2. (A) Cerebral angiography demonstrated a wide-necked (5.69 mm) left middle cerebral artery bifurcation aneurysm. (B) 3-dimensional reconstruction of the aneurysm. (C) Procedural angiography image revealing the two Neuroform Atlas stent deployed into superior and inferior division of left M2 (black head arrows). (D) coils are being deployed into the aneurysmal sac. (E, F) Immediate post-procedural angiography image revealing near complete occlusion of the aneurysm with minimal remnant neck (black head arrows). (G, H) 4 month follow up angiography image showing complete occlusion of the aneurysm without definite in-stent stenosis.

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