Y-Stenting Versus PulseRider-Assisted Coiling in the Treatment of Wide-Neck Bifurcation Aneurysms: Role of Anatomical Features on Midterm Results. Issue 2 (3rd December 2019)

• Record Type: Journal Article
• Authors: Limbucci, Nicola; Cirelli, Carlo; Valente, Iacopo; Nappini, Sergio; Renieri, Leonardo; Laiso, Antonio; Rosi, Andrea; Amadori, Tommaso; Amadori, Andrea; Mangiafico, Salvatore
• Is Part Of: Neurosurgery. Volume 87:Issue 2(2020)
• Page Start: 329
• Page End: 337
• Publication Date: 2019-12-03
• Subjects: Intracranial aneurysm -- Bifurcation aneurysm -- Stent -- Coiling; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyz490
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Y-stenting is an effective but challenging approach for wide-neck aneurysms. PulseRider (PR) (Pulsar/Cerenovus) is a new device designed to provide scaffolding during coiling but has never been compared with other techniques. OBJECTIVE: To compare the immediate and 6-mo results of Y-stenting vs PR assisted coiling. METHODS: A total of 105 consecutive patients were retrospectively divided into 2 groups (73 Y-stenting and 32 PR). All underwent angiographic 6-mo follow-up. We evaluated if some anatomical features could influence treatment results. RESULTS: The groups were homogeneous. Immediate adequate occlusions as well as complication rates were similar in Y-stenting and PR group (94.5% vs 96.9% and 8.2% vs 6.2%, respectively). At 6 mo, adequate occlusion was 93.1% after Y-stenting and 84.3% after PR ( P = .28), complete occlusion was significantly higher after Y-stenting: 90.3% vs 62.5% ( P = .0017). Occlusion grade worsening occurred in 6.9% of Y-stenting and 18.7% of PR patients ( P = .09). Neck size was associated with occlusion grade in both groups. Maximal aneurysm size was associated with occlusion grade in the PR group ( P = .023) but not in the Y-stenting group ( P = .06). After PR, 6-mo occlusion rate was higher in small (< 10 mm) than in large aneurysms ( P = .0094); this was not observed after Y-stenting ( P = .54). Location did not significantly affect the mid-term occlusion rate in both the groups. After PR, occlusion was more stable in basilar than anterior or middle cerebral artery aneurysms. CONCLUSION: Y-stenting and PR are both effective with similar immediate and mid-term results. However, treatment stability seems higher after Y-stenting. Aneurysm size seems to negatively affect PR results.