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Y-Stenting Versus PulseRider-Assisted Coiling in the Treatment of Wide-Neck Bifurcation Aneurysms: Role of Anatomical Features on Midterm Results.

Authors
  • Limbucci, Nicola1
  • Cirelli, Carlo1
  • Valente, Iacopo1, 2
  • Nappini, Sergio1
  • Renieri, Leonardo1
  • Laiso, Antonio1
  • Rosi, Andrea1
  • Amadori, Tommaso1
  • Amadori, Andrea3
  • Mangiafico, Salvatore1
  • 1 Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy. , (Italy)
  • 2 Radiology and Neuroradiology Unit, Catholic University of Sacred Heart, Agostino Gemelli University Polyclinic Foundation, Rome, Italy. , (Italy)
  • 3 Neuroanesthesiology and Intensive Care Unit, Careggi University Hospital, Florence, Italy. , (Italy)
Type
Published Article
Journal
Neurosurgery
Publication Date
Aug 01, 2020
Volume
87
Issue
2
Pages
329–337
Identifiers
DOI: 10.1093/neuros/nyz490
PMID: 31792499
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. To compare the immediate and 6-mo results of Y-stenting vs PR assisted coiling. 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. 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. 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. Copyright © 2019 by the Congress of Neurological Surgeons.

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