Double Stent–Assisted Coil Embolization Treatment for Bifurcation Aneurysms: Immediate Treatment Results and Long-Term Angiographic Outcome

BACKGROUND AND PURPOSE: The goal of endovascular treatment of cerebral bifurcation aneurysms is to achieve safe coiling of the sac along with preserving patency of the diverging branches. Our purpose was evaluate procedural safety and efficacy as well as the long-term durability of endovascular treatment of bifurcation aneurysms with double stent–assisted coiling.

MATERIALS AND METHODS: One hundred ninety-one consecutive patients with bifurcation aneurysms were included in this series. Technical failure occurred in 3 aneurysms (1.5%); 188 patients with 193 aneurysms treated with double stent–assisted coiling were retrospectively evaluated; 113 aneurysms were located at middle cerebral artery bifurcation, 42 at the anterior communicating artery, 22 at the basilar artery bifurcation, and the remaining 16 at the internal carotid artery bifurcation; 132 were small (<10 mm), 56 were large (10–25 mm), and 5 were giant (>25 mm).

RESULTS: The technical success rate of double-stent application was 98.5% (193 aneurysms). In total, there were 5 procedural complications with an associated rate of 2.7%, one of which led to death (0.5%). Delayed ischemic stroke occurred in 2 patients (1.1%). Overall, permanent morbidity occurred in 2 patients, with associated rate of 1.1%. Follow-up was obtained in 186 aneurysms (96.4%), and recanalization occurred in 4 aneurysms (2.2%). In subgroup analysis, the recanalization rate was 3.8% for large aneurysms and 40% for giant aneurysms. No recanalization occurred in small aneurysms.

CONCLUSIONS: Dual stent–assisted coiling of cerebral aneurysms is a feasible and safe procedure. It may offer a curative solution with long-term durability for treatment of wide-neck small and large aneurysms.