Repeat Flow Diversion for Cerebral Aneurysms Failing Prior Flow Diversion: Safety and Feasibility From Multicenter Experience

Stroke ◽  
2021 ◽  
Author(s):  
Mohamed M. Salem ◽  
Ahmad Sweid ◽  
Anna L. Kuhn ◽  
Adam A. Dmytriw ◽  
Santiago Gomez-Paz ◽  
...  
Keyword(s):  
Initial Treatment ◽  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Smoking History ◽  
Secondary Outcome ◽  
Multivariable Logistic Regression Model ◽  
Lower Odds ◽  
Complete Occlusion ◽  
History Of ◽  
Incomplete Occlusion

Background and Purpose: Aneurysmal persistence after flow diversion (FD) occurs in 5% to 25% of aneurysms, which may necessitate retreatment. There are limited data on safety/efficacy of repeat FD—a frequently utilized strategy in such cases. Methods: A series of consecutive patients undergoing FD retreatment from 15 centers were reviewed (2011–2019), with inclusion criteria of repeat FD for the same aneurysm at least 6 months after initial treatment, with minimum of 6 months post-retreatment imaging. The primary outcome was aneurysmal occlusion, and secondary outcome was safety. A multivariable logistic regression model was constructed to identify predictors of incomplete occlusion (90%–99% and <90% occlusion) versus complete occlusion (100%) after retreatment. Results: Ninety-five patients (median age, 57 years; 81% women) harboring 95 aneurysms underwent 198 treatment procedures. Majority of aneurysms were unruptured (87.4%), saccular (74.7%), and located in the internal carotid artery (79%; median size, 9 mm). Median elapsed time between the first and second treatment was 12.2 months. Last available follow-up was at median 12.8 months after retreatment, and median 30.6 months after the initial treatment, showing complete occlusion in 46.2% and near-complete occlusion (90%–99%) in 20.4% of aneurysms. There was no difference in ischemic complications following initial treatment and retreatment (4.2% versus 4.2%; P >0.99). On multivariable regression, fusiform morphology had higher nonocclusion odds after retreatment (odds ratio [OR], 7.2 [95% CI, 1.97–20.8]). Family history of aneurysms was associated with lower odds of nonocclusion (OR, 0.18 [95% CI, 0.04–0.78]). Likewise, positive smoking history was associated with lower odds of nonocclusion (OR, 0.29 [95% CI, 0.1–0.86]). History of hypertension trended toward incomplete occlusion (OR, 3.10 [95% CI, 0.98–6.3]), similar to incorporated branch into aneurysms (OR, 2.78 [95% CI, 0.98–6.8]). Conclusions: Repeat FD for persistent aneurysms carries a reasonable success/safety profile. Satisfactory occlusion (100% and 90%–99% occlusion) was encountered in two-thirds of patients, with similar complications between the initial and subsequent retreatments. Fusiform morphology was the strongest predictor of retreatment failure.

Analyzing the effects of depression among patients with head and neck cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18038-e18038
Author(s):  
Muhammad Usman Zafar ◽  
Zahid Tarar ◽  
Ghulam Ghous ◽  
Umer Farooq ◽  
Masood Anwar
Keyword(s):  
Head And Neck Cancer ◽  
Length Of Stay ◽  
Head And Neck ◽  
Neck Cancer ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Prior History ◽  
Lower Odds ◽  
History Of

e18038 Background: Patients with head and neck cancer carry the prospect of facial disfigurement in addition to the effects on speech, smell, sight, and taste. As such they are at a higher risk of acquiring emotional distress. Despite this, depression is underreported in this population. We review the National Inpatient Sample (NIS) to understand the effects of depression in patients admitted with any diagnosis of head and neck cancer. Methods: We designed a retrospective study and utilized NIS data for the year 2018. We identified patients with any history of Head and Neck cancer using their specific ICD-10 codes. We also identified codes for depressive disorders. Primary outcome was effect of depression on comorbidities. Secondary outcome was hospital length of stay. Utilizing STATA MP 16.1 we performed multivariate logistic regression analysis. Various comorbidities including previous history of coronary artery disease, congestive heart failure, stroke, smoking, hyperlipidemia, and chemotherapy were incorporated into the analysis. Results: The study population included 15,689 patients that were 18 years or older. Mean age was 64 years. Only 28% of the population was females. The mean hospital length of stay was approximately 7 days. In this group of patients, 12% had a history of depression. Among the different types of head and neck cancers oropharyngeal cancers had the highest percentage of depression rates (14%). In multivariable analysis, patients with depression had a higher comorbidity index but this result did not reach statistical significance (Odds Ratio (OR) 1.02, p = 0.054, 95% Confidence Intervals (CI) 0.999 – 1.045). Patients had higher odds of having depression if they also had a history of stroke (OR 1.4, 95% CI 1.13 – 1.73), prior history of chemotherapy (OR 1.25, 95% CI 1.09 – 1.43), history of hyperlipidemia (OR 1.31, 95% CI 1.16 – 1.48) or were admitted over the weekend (OR 1.21, 95% CI 1.07 – 1.38). Younger age was associated with lower odds of depression (OR 0.98, 95% CI 0.98 – 0.99). Women had higher odds of having depression (OR 1.68, 95% CI 1.51 – 1.88). When compared with white people, people from the following demographics had lower odds of depression – Black (OR 0.56, 95% CI 0.47 – 0.68), Hispanic (OR 0.64, 95% CI 0.49 – 0.83), Asian (OR 0.26, 95% CI 0.17 – 0.43), and others (OR 0.53, 95% CI 0.35 – 0.79). Hospital length of stay was higher among patients with depression (OR 0.7, 95% CI 0.2 – 1.15). Conclusions: Among patients with head and neck cancer, odds of having depression are higher in the white population, older patients, females and patients with prior history of chemotherapy. Depression is associated with higher hospital length of stay. These findings help understand the effect of depression on this susceptible population and identify at risk patients for appropriate screening.

scholarly journals Associations of hypertension Diabetes Smoking History and SNPs with Responses to Aflibercept Treatment for tAMD and PCV

2019 ◽  
pp. 170-177
Author(s):  
Tanaka K ◽  
Furuya K ◽  
Mori R ◽  
Kawamura A ◽  
Yuzawa M ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Initial Treatment ◽  
Smoking History ◽  
Diabetic Patients ◽  
Therapeutic Effects ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
History Of ◽  
One Year ◽  
The One

Purpose: To determine the correlation between therapeutic effects of IVA treatment on typical AMD (tAMD), and polypoidal choroidal vasculopathy (PCV) and the history of hypertension, diabetes mellitus, smoking history and single nucleotide polymorphisms (SNPs).Methods: Prospective, interventional study. Subjects were assigned to 125 untreated patients with exudative AMD (tAMD: 58 patients, PCV: 67 patients, male: 91:34, mean age 73.4 years). Among the tAMD patients, there were 28 bimonthly injections 30 who received pro re nata (PRN) injections after three monthly injections. Among the PCV patients, 33 were treated with bimonthly injections and 34 received PRN injections after three monthly injections. Therapeutic effects were evaluated by best-corrected visual acuity (BCVA), central retinal thickness (CRT), subfoveal choroidal thickness (CCT), and exudative change after 3 months and 1 year from initial treatment, and also the history of hypertension, diabetes mellitus, smoking and five SNPs (rs10490924, rs800292, rs699947, rs1061170, rs13278062).Results: Improvements of BCVA, CRT were observed in all groups at 1 year after initial treatment. The one-yearchange in CRT showed significant improvement in nonsmokers than smokers in tAMD. The one-year change in CRT indicated a significant improvement in non-diabetic patients in PCV. There was more exudation at both 3 months and 1 year who had smoking history in tAMD. With respect to the rs1061170 mutation of tAMD, in the case with TT type, significant residual exudation was noted at both 3 and 12 months.Conclusions: The history of smoking and diabetes could be influence to IVA treatment for AMD.

scholarly journals Endovascular embolization of branch-incorporated cerebral aneurysms

2017 ◽  
Vol 30 (6) ◽  
pp. 600-606 ◽  
Author(s):  
Yasuhiro Kawabata ◽  
Takuya Nakazawa ◽  
Shunichi Fukuda ◽  
Satoru Kawarazaki ◽  
Tomokazu Aoki ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Posterior Communicating Artery ◽  
Endovascular Coiling ◽  
Modified Rankin Scale ◽  
Dominant Type ◽  
Complete Occlusion ◽  
Grade 5 ◽  
Incomplete Occlusion

Objectives The aim of this study was to examine the feasibility, technique, and clinical and angiographic outcomes of endovascular coiling to treat a cerebral aneurysm with a branch incorporated into the aneurysmal wall. Methods From 2012 to 2016, 25 patients with 26 cerebral aneurysms having a branch incorporated into the aneurysm (9 unruptured, 17 ruptured) were treated to prevent rupture or re-bleeding from the sac while preserving the incorporated branch by using single-catheter ( n = 18), balloon-remodeling ( n = 4), stent-assisted coiling ( n = 3), or double-catheter ( n = 1) techniques. Results Endovascular coiling was conducted in 26 procedures without angiographic occlusion of the incorporated branch. Post-embolization angiography revealed near-complete occlusion ( n = 8; 30.7%), neck remnant ( n = 13; 50%), and incomplete occlusion ( n = 5; 19.3%) aneurysms. Thromboembolisms were observed in four (15.4%) patients during or after the procedure. A procedure-related neurological deficit was observed in one (3.8%) patient. When patients with a preictal modified Rankin Scale (mRS) score of 3 presenting with grade 5 subarachnoid hemorrhage were excluded, all patients had favorable outcomes (mRS 0–2). Six (23.1%) recurrent aneurysms were observed during follow-up, five of which were treated endovascularly at 5–22 months without complication. The location of an aneurysm at the ICA-posterior communicating artery associated with the dominant-type posterior communicating artery was significantly associated with recurrence ( p = 0.041). Conclusions Cerebral aneurysms with an incorporated branch were safely treated using conventional endovascular coiling. However, treatment durability was unsatisfactory, especially for dominant-type ICA-posterior communicating artery aneurysms.

scholarly journals Novel use of flow diversion for the treatment of aneurysms associated with arteriovenous malformations

2017 ◽  
Vol 42 (6) ◽  
pp. E7 ◽  
Author(s):  
Craig Kilburg ◽  
Philipp Taussky ◽  
M. Yashar S. Kalani ◽  
Min S. Park
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Arteriovenous Malformations ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Complete Occlusion ◽  
Martin Grade ◽  
Flow Diverting Stent

The use of flow-diverting stents for intracranial aneurysms has become more prevalent, and flow diverters are now routinely used beyond their initial scope of approval at the proximal internal carotid artery. Although flow diversion for the treatment of cerebral aneurysms is becoming more commonplace, there have been no reports of its use to treat flow-related cerebral aneurysms associated with arteriovenous malformations (AVMs). The authors report the cases of 2 patients whose AVM-associated aneurysms were managed with flow diversion. A 40-year-old woman presented with a history of headaches that led to the identification of an unruptured Spetzler-Martin Grade V, right parietooccipital AVM associated with 3 aneurysms of the ipsilateral internal carotid artery. Initial attempts at balloon-assisted coil embolization of the aneurysms were unsuccessful. The patient underwent placement of a flow-diverting stent across the diseased vessel; a 6-month follow-up angiogram demonstrated complete occlusion of the aneurysms. In the second case, a 57-year-old man presented with new-onset seizures, and an unruptured Spetzler-Martin Grade V, right frontal AVM associated with an irregular, wide-necked anterior communicating artery aneurysm was identified. The patient underwent placement of a flow-diverting stent, and complete occlusion of the aneurysm was observed on a 7-month follow-up angiogram. These 2 cases illustrate the potential for use of flow diversion as a treatment strategy for feeding artery aneurysms associated with AVMs. Because of the need for dual antiplatelet medications after flow diversion in this patient population, however, this strategy should be used judiciously.

scholarly journals Impact of history of myomectomy on preterm birth risk in women with a leiomyomatous uterus: a propensity score analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Emmanuel Rault ◽  
Pierre Delorme ◽  
François Goffinet ◽  
Aude Girault
Keyword(s):  
Preterm Birth ◽  
Propensity Score ◽  
Propensity Score Analysis ◽  
Sensitivity Analyses ◽  
Secondary Outcome ◽  
Spontaneous Preterm Birth ◽  
Multivariable Logistic Regression Model ◽  
Score Analysis ◽  
Tertiary Center ◽  
History Of

Abstract Background To evaluate if women with a history of myomectomy have a modified preterm birth risk compared to women with myomas during pregnancy. Methods Retrospective cohort study including all women with a history of myomectomy (operated group) or uterine myomas during pregnancy (unoperated group) who delivered in a tertiary center between January, 2011 and December, 2017. The operated group included women who had a myomectomy history with or without myomas during the ongoing pregnancy. The unoperated group included women with uterine myoma(s) seen on at least one ultrasound during pregnancy without history of myomectomy. The primary outcome was preterm birth < 37 weeks, and the secondary outcome spontaneous preterm birth < 37 weeks. To control for confounding factors, a propensity score approach was used. Two sensitivity analysis were performed, one repeating the analysis using the propensity score after excluding operated women with persistent myomas and one using a classical multivariable logistic regression model. Results The cohort included 576 women: 283 operated women and 293 unoperated women. The rate of preterm birth was similar in the two groups: 12.6% in the unoperated group and 12.0% in the operated group (p = 0.82). No difference in preterm birth risk was shown between unoperated and operated women in the cohort matched on the propensity score: OR 0.86; 95%CI [0.47–1.59]. These results were consistent for spontaneous preterm birth (OR 1.61; 95%CI [0.61–4.23]) and for the sensitivity analyses. Conclusion In women with a leiomyomatous uterus, a history of myomectomy is not associated with a reduced preterm birth risk.

Abstract 1122‐000158: Flow Diversion of Cerebral Aneurysms via Direct Carotid Artery Cutdown: A Case Series

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Yahia M Lodi ◽  
Varun V Reddy ◽  
Adam Cloud ◽  
Zara T Lodi ◽  
Ravi Pande
Keyword(s):  
Carotid Artery ◽  
Case Series ◽  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Vascular Surgeon ◽  
Clinical Events ◽  
History Of ◽  
Severity Of The Disease ◽  
Arch Aneurysm

Introduction : Flow diversion (FD) of the cerebral aneurysms (CA) are performed either by trans femoral or transradial approach. Safety and feasibility of an alternative option such as direct Carotid artery Cutdown (DCAC) and FD for the treatment of the CA in a situation when tradition approaches are not feasible is not well described. Methods : Retrospective review. Results : First patient; 67 years old man with history of hypertension, hyperlipidemia, smoking, and stenting of the aortic arch aneurysm was diagnosed with symptomatic bilateral ICA DSA buy a CT angiography. Right ICA DSA was in multi‐level extending from cervical carotid artery to the skull base measured 19 × 15 × 20 mm and the left was 16 × 9 × 22 mm. Considering the severity of the disease and the presence of symptoms, planned for a DCAC by vascular surgeon followed by FD by neurovascular surgeon (NES) in a staged fashion. A 6F sheath was placed from right common carotid artery (CCA) to right ICA by a vascular surgeon. A CAT5 catheter was navigated to the ICA beyond DSA. FD was achieved using Surpass streamline measuring 4 × 50 mm x2 and a 5 × 40 mm. The DCAC site was sutured by vascular surgeon and patient was extubated. Using similar techniques, Left‐sided DPA was repaired using 5 × 50 mm surpass streamline flow diverter in 3 months. Second patient; 75 years old women’s let ICA opththalmic (ICA‐O) aneurysm grown from 8 mm to 12 mm with headaches. TF and TR approaches failed, underwent DCAC and FD with pipeline flex (PF) 5 × 30 mm using phenom plus and phenom XT27 microcatheter. Third patient; 65 years old women with LICA‐0 9 mm symptomatic aneurysm with occlusions femoral and radial arteries due to smoking underwent FD with PF of 4 × 30 mm. There were no clinical events, first patient’s right ICA radiographic dissection was repaired by VS prior to extubation. Patients were discharged home in 48 hours with NIHSS 0 and achieved baseline mRS. Patients were continued full antiplatelets for six months followed by an 81 mg baby aspirin and 75 mg of clopidogrel. Follow‐up MR angiogram demonstrate complete obligations of the aneurysms without stenosis. Conclusions : Our case series demonstrate that DCAC for the FD of the intracranial aneurysm is feasible and safe when performed carefully and in coordination with a multidisciplinary team. Further studies are required.

Abstract WMP34: Low Yield of Further Angiographic Follow-up in Adequately Occluded Aneurysms After Flow Diversion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nohra Chalouhi ◽  
Guilherme Barros ◽  
Stavropoula Tjoumakaris ◽  
Ayan Kumar ◽  
Michael Lang ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
New Technology ◽  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Inclusion Criteria ◽  
Short Term ◽  
Complete Occlusion ◽  
Aneurysm Occlusion ◽  
Repeat Angiography

Background: Aneurysm recurrence after coil therapy remains a major shortcoming in the endovascular management of cerebral aneurysms. Flow diversion has emerged as a promising treatment for intracranial aneurysms. The safety and efficacy of this new technology is under investigation. The current study assesses the yield of further angiographic follow-up in aneurysms that have achieved adequate occlusion after treatment with the Pipeline Embolization Device (PED). Methods: Inclusion criteria were as follows: 1) treatment of one or more aneurysms with the PED, 2) available short-term (<12 months) follow-up digital subtraction angiography (DSA), 3) complete (100%) or near-complete (>95%) occlusion on short-term follow-up DSA, and 4) available further angiographic follow-up (DSA or MRA). Results: A total of 175 patients matching the inclusion criteria were identified. Aneurysm size was 9.0 mm on average. Mean angiographic follow-up was 23.4 months. On short-term follow-up DSA images, 154 (88%) had complete aneurysm occlusion and 21 (12%) had near-complete occlusion. Seven patients (4%) had further DSA follow-up alone, 39 patients (22%) had further DSA and MRA follow-up, and 129 patients (74%) had further MRA follow-up alone. On further angiographic follow-up (DSA or MRA), no patient had a decrease in the degree of aneurysm occlusion (recurrence) or required retreatment. Of the 21 patients with near-complete occlusion on initial DSA images, 5 patients (24%) progressed to complete aneurysm occlusion on further angiographic follow-up. No patient had evidence of new in-stent stenosis on further angiographic follow-up. Conclusion: In this study, the diagnostic yield of repeat angiography in adequately occluded aneurysms with the PED was very low. Based on these findings, we do not recommend further angiographic follow-up once aneurysms have achieved adequate occlusion with the PED.

Flow-Diversion for Ophthalmic Segment Aneurysms

Neurosurgery ◽  
2015 ◽  
Vol 76 (3) ◽  
pp. 286-290 ◽  
Author(s):  
Mario Zanaty ◽  
Nohra Chalouhi ◽  
Guilherme Barros ◽  
Eric Winthrop Schwartz ◽  
Mark Philip Saigh ◽  
...  
Keyword(s):  
Complication Rate ◽  
Flow Diversion ◽  
High Rate ◽  
Complication Rates ◽  
Complete Occlusion ◽  
Obliteration Rate ◽  
Visual Symptoms ◽  
Aneurysm Occlusion ◽  
Ophthalmic Segment Aneurysms ◽  
Incomplete Occlusion

Abstract BACKGROUND: The use of flow-diversion to treat ophthalmic segment aneurysms (OSA) has not been well evaluated. OBJECTIVE: To assess the visual outcomes, the obliteration rate, and the need for retreatment of OSA treated by the pipeline embolization device (PED). METHODS: Patients who underwent treatment with PED for OSA from 2009 to 2014 were selected and retrospectively reviewed. Patient's age, sex, mode of presentation, and aneurysm size were recorded. The complication rates, the need for retreatment (due to recurrence of the aneurysm or worsening symptoms), the aneurysm occlusion rates, the evolution of visual symptoms, and the evolution of headache/retro-orbital pain were registered. RESULTS: Forty-one patients harboring 44 OSA treated by flow-diversion were identified. Females constituted 87.80% (37/41) of the cohort. The mean age was 59.16 ± 12.54 years. At final angiographic follow-up, 77.27% (34/44) had complete occlusion, 6.81% (3/44) had near-complete occlusion, and 15.90% (7/44) had incomplete occlusion. Of the 22 symptomatic OSA, complete resolution or significant improvement was noted in 72.72% (16/22), while worsening of symptoms occurred in 4.54% (1/22). Five patients out of 22 (22.72%; 5/22) had no significant changes in their symptoms. The complication rate was 2.27% (1/44). The mortality rate was 0%. CONCLUSION: The low complication rate, the high obliteration rate, and the high rate of improvement in the visual symptoms make flow-diversion an appealing option for the treatment of OSA.

scholarly journals Repeat Flow Diversion for Previously Failed Flow Diversion in A Multicenter Cohort

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Mohamed M Salem ◽  
Ahmad Sweid ◽  
Anna L Kuhn ◽  
Adam A Dmytriw ◽  
Muhammad Waqas ◽  
...  
Keyword(s):  
Initial Treatment ◽  
Clinical Status ◽  
Subsequent Treatment ◽  
Flow Diversion ◽  
Small Subset ◽  
Complete Occlusion ◽  
Maximal Diameter ◽  
Aneurysm Occlusion ◽  
Treatment Procedures

Abstract INTRODUCTION Aneurysmal persistence after pipeline embolization device (PED) treatment occurs in a small subset of treated aneurysms which might necessitate further treatment. Most cases are managed by deploying another PED in a telescoping fashion within the existing PED. There is no existing data in the literature regarding the efficacy of such strategy. METHODS A retrospective review of repeated attempts at flow diversion in 7 North-American cerebrovascular centers was performed. Patients were included if the repeat flow diversion occurred at least 6 months after initial treatment. Patients with no radiological follow up after second treatment were excluded. Clinical and radiographic data was collected from the records. The primary outcome was aneurysm occlusion at last follow-up with secondary outcomes of clinical status and complications. RESULTS A total of 58 patients (median age 57 yr, 89.7% females) harboring 58 aneurysms underwent 122 treatment procedures. Majority of aneurysms were unruptured (91.3%); 82.8% were saccular and 91.4% were located in the internal carotid artery with a mean maximal diameter of 9.5 mm. 52 patients were treated twice while 6 patients were treated 3 times. A single device was used in 87.9% of the patients in the initial treatment procedure, and in 94.8% of the patients in the subsequent treatment attempt. Mean elapsed-time between first and second treatment was 13.5 mo. Last imaging follow-up was performed at median of 33.4 mo after initial treatment, showing complete occlusion in 53.4%, and near complete occlusion (90%-99%) in 15.5% of aneurysms. Transient ischemic neurologic complications were encountered in 3.4% of patients, with no permanent complications. Last follow up mRS of 0-2 were noted in 100% of patients, with mean clinical follow up of 37 mo. 57 (98.3%) patients had a final disposition to their own home. CONCLUSION Repeat flow diversion for persistent aneurysms is associated with a reasonable chance of success and acceptable safety profile.

Mid-term Results of Endovascular Coiling of Wide-Necked Aneurysms Using Double Stents in a Y Configuration

Neurosurgery ◽  
2011 ◽  
Vol 69 (2) ◽  
pp. 421-429 ◽  
Author(s):  
Alejandro M. Spiotta ◽  
Rishi Gupta ◽  
David Fiorella ◽  
Vivekananda Gonugunta ◽  
Bjorn Lobo ◽  
...  
Keyword(s):  
Initial Treatment ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Thromboembolic Complications ◽  
Endovascular Management ◽  
Spontaneous Thrombosis ◽  
Complete Occlusion ◽  
Neck Recurrence ◽  
Mid Term Results

Abstract BACKGROUND: Double stenting in a Y configuration may be used to treat a subset of wide-necked aneurysms not amenable to reconstruction with a single stent. OBJECTIVE: We studied the feasibility, safety, and mid-term angiographic outcome of patients treated using this technique. METHODS: A retrospective review was undertaken of all coil embolizations of wide-necked aneurysms using double stents in a Y configuration. RESULTS: Nineteen patients were identified from 2002 to 2010 (14 women, 5 men) with a mean age of 57.4 years. Stents were deployed in a Y configuration achieving complete occlusion (5/19), residual neck (5/19), and residual aneurysm filling (9/19). Angiographic follow-up was available for a mean of 16 months, and clinical follow up was available for a mean of 21.4 months. The incidence of complications at the initial treatment was 6 of 19 (31.6%), and delayed thromboembolic complications occurred in 2 of 19 (10.5%). An angiographic neck recurrence requiring retreatment developed in only 1 of the patients in whom complete occlusion was obtained with the initial treatment. Spontaneous thrombosis and complete occlusion on follow-up imaging were found in 6 patients in whom initial neck or aneurysm filling was observed. Ultimately, 12 of the aneurysms (63.2%) were completely occluded on follow-up angiography. CONCLUSION: Y-stent reconstruction enables the endovascular management of otherwise complex, wide-necked cerebral aneurysms and can be performed safely in experienced hands with satisfactory mid-term results, even in cases requiring retreatment.

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