Y stenting using kissing stents for the treatment of bifurcation aneurysms.

Abstract

Coiling of wide neck, bifurcation aneurysms often requires creative techniques to ensure optimal and safe embolization. The Y stenting technique utilizing kissing stents provides an alternative endovascular treatment of this complex pathology. A triple wire technique was used to place side by side stents within the parent artery and extending into the bilateral bifurcation vessels. The third wire enabled placement of a microcatheter within the aneurysm, which remained trapped by the opposing stents. 9 patients obtained acceptable angiographic partial or total occlusion of their aneurysm. Follow-up was variable, ranging from none to 26 months. There were two early deaths at postprocedures day 1 and 10, with one mortality being a direct result of the intervention. One patient experienced delayed in-stent thrombosis resulting in a periprocedural morbidity and mortality of 11% and 22%, respectively. One patient required retreatment. Y stenting utilizing the triple catheter technique is an alternative endovascular treatment for wide neck, bifurcation aneurysms. Caution should be used, especially in the setting of subarachnoid hemorrhage, as the complication rate and overall risk increase significantly with this technique's complexity.