Stent-assisted coiling strategies for the treatment of wide-necked basilar artery bifurcation aneurysms

Abstract

Stent-assisted coiling is now the preferred treatment option for wide-necked basilar artery bifurcation aneurysms (BABA). However, the optimal choice of specific treatment strategies is still not well documented. In this paper, based on the “two-neck” theory of BABA, we classified the stent-assisted coiling treatment of BABA into three types: unilateral stent-assisted coiling, unilateral stent plus contralateral microcatheter or microwire-assisted coiling, and bilateral stent-assisted coiling. We assessed the feasibility and effectiveness of different stent-assisted coiling strategies for the treatment of BABA. Twenty-three BABA patients treated with stent-assisted coiling between May 2003 and September 2012 were included. Of the 23 aneurysms, 16 were treated with unilateral stent-assisted coiling, two were treated with unilateral stent and microcatheter or microwire-assisted coiling, and five were treated with bilateral stent-assisted coiling. All 23 BABA were successfully embolized, with a technical success rate of 100%. According to the Raymond classification, the immediate procedural outcome was grade I in nine patients, grade II (neck residue) in four patients and grade III (body filling) in 10 patients. The rate of procedure-related complications was 4.3% (1/23), where intra-operative hemorrhage occurred during coiling due to rupture of the aneurysm. Of the 23 patients, 16 (69.6%) had angiographic follow-up. The mean follow-up duration was 13.5months (range 1–46months). Angiographic follow-up showed complete occlusion in 10 patients (62.5%), improvement in two patients (12.5%), stability in three patients (18.7%), and recanalization in one patient (6.25%). The various stent-assisted coiling strategies available at present are feasible and effective for the treatment of wide-necked BABA.