Y-Stent-Assisted Coiling of Wide-Neck Bifurcation Intracranial Aneurysms: A Meta-Analysis (original) (raw)

Abstract

BACKGROUND: Y-stent-assisted coiling for wide-neck intracranial aneurysms required further investigation. Our aim was to analyze outcomes after Y-stent placement in wide-neck aneurysms. We performed a systematic search of 3 data bases for studies published from 2000 to 2018. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting Y-stent-assisted coiling of wide-neck aneurysms. DATA ANALYSIS: Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and factors influencing the studied outcomes. We included 27 studies and 750 aneurysms treated with Y-stent placement. The immediate complete/near-complete occlusion rate was 82.2% (352/468; 95% CI, 71.4%-93%; I 2 ϭ 92%), whereas the long-term complete/near-complete occlusion rate was 95.4% (564/598; 95% CI, 93.7%-97%; I 2 ϭ 0%) (mean radiologic follow-up of 14 months). The aneurysm recanalization rate was 3% (20/496; 95% CI, 1.5%-4.5%; I 2 ϭ 0%), and half of the recanalized aneurysms required retreatment. The treatment-related complication rate was 8.9% (63/614; 95% CI, 5.8%-12.1%; I 2 ϭ 44%). Morbidity and mortality after treatment were 2.4% (18/540; 95% CI, 1.2%-3.7%; I 2 ϭ 0%) and 1.1% (5/668; 95% CI, 0.3%-1.9%; I 2 ϭ 0%), respectively. Crossing Y-stent placement was associated with a slightly lower complication rate compared with the kissing configuration (56/572 ϭ 8.4%; 95% CI, 5%-11%; I 2 ϭ 46% versus 4/30 ϭ 12.7%; 95% CI, 3%-24%; I 2 ϭ 0%). Occlusion rates were quite comparable among Enterprise, Neuroform, and LVIS stents, whereas the Enterprise stent was associated with lower rates of complications (8/89 ϭ 6.5%; 95% CI, 1.6%-11%; I 2 ϭ 0%) compared with the others (20/131 ϭ 14%; 95% CI, 5%-26%; I 2 ϭ 69% and 9/64 ϭ 11%; 95% CI, 3%-20%; I 2 ϭ 18%). This was a small, retrospective series. CONCLUSIONS: Y-stent-assisted coiling yields high rates of long-term angiographic occlusion, with a relatively low rate of treatmentrelated complications. Y-stent placement with a crossing configuration appears to be associated with better outcomes. Although Y-configuration can be obtained using many types of stents with comparable occlusion rates, the Enterprise stent is associated with lower complication rates. ABBREVIATIONS: IQR ϭ interquartile range; PRISMA ϭ Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SAC ϭ stent-assisted coiling; Y-SAC ϭ Y-stent-assisted coiling W ith the improvement of angiographic imaging, operator experience, and widespread use of more complex techniques, an increased number of intracranial aneurysms can be effectively treated with endovascular techniques. However, aneurysms with wide necks, unfavorable anatomic configurations, and partial incorporation of bifurcation branches are still challenging lesions for endovascular treatment, and each technique presents specific limitations. Balloon-assisted coiling may not be suitable in case of very wide-neck aneurysms with complex anatomy. 1

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