Introduction: Stent-coiling of bifurcation aneurysms has significantly expanded the spectrum of aneurysms amenable to endovascular therapy. A variety of techniques have evolved to deal with wide necked bifurcation aneurysms such as Y-stenting and WEB embolization device. In our two institutions, we have primarily used a single stent-coiling to treat most bifurcation aneurysms. We present a large series in which a single stent was utilized with angiographic and clinical outcomes.
Methods: Two academic institutions in the United States contributed a prospectively maintained data on consecutive patients with bifurcation aneurysms treated with single stent-coiling between 2007 and 2015.
Results: A total of 58 bifurcation aneurysms were treated with single stent-coiling at the two institutions. The aneurysms were located in the basilar bifurcation in 51.7%, carotid bifurcation in 24.1%, middle cerebral artery bifurcation in 19%, and anterior communicating artery bifurcation in 5.2%. The median aneurysm diameter, neck size, height, width, and aspect ratio were 8.4 mm, 6 mm, 7.5 mm, 7.4 mm, and 1.5, respectively. Median length of follow-up was 16.5 months. Complete occlusion at last follow-up was achieved in 70.6% of cases, residual neck was found in 21.6%, and residual aneurysm was found in 7.8%. Retreatment was needed in 12.1% of cases due to recanalization. There was a significant association between complete occlusion and smaller neck size (notably < 6 mm; p = 0.036) and smaller width (notably < 7.5 mm; p = 0.022). Furthermore, complete occlusion rate was lower in basilar bifurcation aneurysms (p = 0.088) and in large bifurcating angle (notably >180°; p = 0.034). Symptomatic complications occurred in 6.9% of cases. There was no mortality.
Conclusions: Treatment of bifurcation aneurysm using single stent-coiling is considered safe and effective. Complete and near complete occlusion were achieved in 92.2% of cases. Residual aneurysm or recanalization was found only in 7.8% of cases. Therefore, the use of Y-stenting or other devices can be limited to a subset of basilar bifurcation aneurysms, with aneurysm neck wider than 7 mm and or those with a bifurcation angle greater than 180°.
Patient Care: The use of single stent-coiling is technically easier in treatment of bifurcation aneurysms. In this study we show that this technique is also effective and more complicated methods can be reserved for only a subset of aneurysms.
Learning Objectives: 1- To determine the effectiveness of using one stent-coiling in treatment of bifurcation aneurysms, and the need for Y-stenting or other devices.
2- To determine the effect of aneurysms measurements and configuration on outcome