Treatment Of Wide-neck Bifurcation Aneurysms Research Articles

The Barrel vascular reconstruction device for endovascular coiling of wide-necked intracranial aneurysms: a multicenter, prospective, post-marketing study

Background and purposeThe Barrel vascular reconstruction device (Barrel VRD) is a novel stent with design features that allow endovascular coiling of wide-necked bifurcation aneurysms while preserving adjacent branches, without necessitating...

Systematic Review of Woven EndoBridge for Wide-Necked Bifurcation Aneurysms: Complications, Adequate Occlusion Rate, Morbidity, and Mortality.

Although the Woven EndoBridge (WEB [Sequent Medical, Aliso Viejo, California, USA]) is a highly innovative technique for the endovascular treatment of wide-necked bifurcation aneurysms (WNBAs), there are no studies available comparing this technique with surgical results or other endovascular results of stent-assisted coiling or balloon-assisted coiling for WNBAs. The purpose of this study was to assess complications, complete occlusion rate, and morbidity and mortality of the WEB in WNBA treatment. Published literature citing embolization results for WNBAs using the WEB was reviewed. A systematic review was performed to evaluate the complications, complete occlusion rate, and morbidity and mortality. We identified 19 studies, including 935 patients. The most frequent aneurysm locations were the bifurcation of the middle cerebral artery (MCA) (42.8%), the anterior communicating artery (23%), and the basilar bifurcation (20.8%). The technical success rate of the WEB was 97% (95% confidence interval [CI], 96%-98%). The thromboembolic complication rate was 8% (95% CI, 6%-11%). The thromboembolic complication rate was 10% (95% CI, 7%-13%) in cases before 2013, which was higher than in cases after 2013 (6%; 95% CI, 4%-9%; P= 0.045). MCA bifurcation aneurysm has a higher thromboembolic complication rate than posterior circulation aneurysm. The overall bleeding complication rate of the WEB was 2% (95% CI, 1%-3%). The adequate occlusion rate was 81% (95% CI, 76%-85%). Morbidity during follow-up was 3% (95% CI, 1%-4%) (I2= 30.4%), and mortality was 2% (95% CI, 1%-3%). Adequate aneurysm occlusion was found in 81% of WEB cases with low morbidity and mortality.

Safety and efficacy of aneurysm treatment with WEB in the cumulative population of three prospective, multicenter series

BackgroundFlow disruption with the WEB is an innovative endovascular approach for treatment of wide-neck bifurcation aneurysms. Initial studies have shown a low complication rate with good efficacy.PurposeTo report clinical and...

Physician training protocol within the WEB Intrasaccular Therapy (WEB-IT) study

IntroductionThe WEB Intra-saccular Therapy (WEB-IT) trial is an investigational device exemption study to demonstrate the safety and effectiveness of the WEB device for the treatment of wide-neck bifurcation aneurysms. The...

Abstract 203: Safety And Efficacy Of WEB ® Aneurysm Treatment: Combined Analysis 0f WEBCAST, French Observatory, And WEBCAST2 Studies - Final Results.

Purpose: WEB Flow disruption is an innovative endovascular treatment for wide-neck bifurcation aneurysms. Safety and efficacy are analyzed in the cumulated population of 3 prospective multicenter GCP (Good Clinical Practice) studies conducted in Europe (WEBCAST, French Observatory, WEBCAST2). Methods: Patients with wide neck bifurcation aneurysms were included in these 3 studies. An independent medical monitor independently analyzed adverse events. An independent expert in Interventional Neuroradiology evaluated anatomical results at 12 months using the 3 grades scale: complete occlusion, neck remnant, and aneurysm remnant. Results: A total of 168 patients with 169 aneurysms including 14 ruptured (8.3%) were included in the 3 studies. Eighty-six out 169 aneurysms were located at middle cerebral artery (50.9%), 36/169 at anterior communicating artery (21.3%), 30/169 at basilar artery (17.8%), and 17/169 at internal carotid artery terminus (10.1%). Placement of the WEB device was feasible in 163/169 aneurysms (96.4%). Morbidity and mortality at one month were reported in 4/168 patients (2.4%) and 0/168 patients (0.0%), respectively. Anatomical results at 12 months were complete aneurysm occlusion in 82/149 aneurysms (55.0%), neck remnant in 38/149 aneurysms (25.5%), and aneurysm remnant in 29/149 aneurysms (19.5%). Conclusion: This analysis in the large cumulated population of 3 GCP studies confirms the high safety of WEB treatment with low morbidity and mortality. At 12 months, adequate occlusion (complete occlusion and neck remnant) was obtained in a high percentage of aneurysms (80.5%).

The pCONus Device in Treatment of Wide-necked Aneurysms : Technical and Midterm Clinical and Angiographic Results.

Avariety of devices for treatment of wide-necked bifurcation aneurysms are emerging. Here we report our results using the new pCONus device with special emphasis on the morphological and anatomical requirements for successful implantation. In this study we treated 21patients with 22aneurysms by endovascular interventions. After providing informed consent, patients were included according to the following criteria: aneurysm dome to neck ratio <2 or neck diameter >4mm. The primary end points for clinical safety were the absence of death, absence of major or minor stroke and absence of transient ischemic attack. A total of 22 aneurysms in 21patients were treated with pCONus-assisted coiling. In 19patients harboring 20aneurysms the implantation of the device was successful and these aneurysms showed an adequate occlusion after 6months in 95 %. The complication rate was low (5 %) with one case of minor neurological stroke. Analysis of the data showed that the difference in aneurysm angulation between successful (mean45°) and failed implantations (mean71.5°) was highly significant. Use of the pCONus device and coiling in wide-necked bifurcation aneurysms is safe and provides good occlusion rates but might be limited by the angulation between the aneurysm and the parent vessel.

Are Anatomic Results Influenced by WEB Shape Modification? Analysis in a Prospective, Single-Center Series of 39 Patients with Aneurysms Treated with the WEB

Endovascular treatment with the flow-disrupter Woven EndoBridge aneurysm embolization system (WEB) is an innovative treatment for wide-neck bifurcation aneurysms. Prospective, multicenter studies have shown the high safety of this technique. Stability of aneurysm occlusion in long-term follow-up has been rarely studied. Moreover the "compression" phenomenon has been reported and seems to be associated with poor anatomic results. This prospective, single-center series analyzes the safety and efficacy of the WEB device in long-term follow-up in relation to WEB shape modification. All patients with aneurysms treated with the WEB were prospectively included in a data base. Demographics, aneurysm characteristics, adverse events, and anatomic results were retrospectively analyzed. Anatomic results and modification of the WEB shape on the follow-up examinations were independently evaluated by a core laboratory. Thirty-nine patients were included. We observed few complications: intraoperative rupture in no patients (0.0%) and thromboembolic events in 3 patients (7.7%) with a permanent deficit in 1 (2.6%). At short-term, midterm, and long-term follow-up, adequate occlusion was obtained in 86.8%, 83.3%, and 87.5%, respectively. Retreatment rates were low (5.1%). At 6 months, WEB shape modification (compression/retraction) was observed in 31.6% of patients but was not associated with a lower rate of adequate occlusion. This prospective, single-center series with WEB devices used in 39 patients during 3.5 years confirms data from previous multicenter studies. Treatment can be accomplished with good safety and efficacy, with a high rate of adequate occlusion. Anatomic results were not worse in case of WEB shape modification.

Woven Endobridge (WEB) device for endovascular treatment of complex unruptured aneurysms-a single center experience.

The introduction of the Woven Endobridge (WEB) device increases the feasibility of endovascular treatment of wide-neck bifurcation aneurysms with limitations given by currently available sizes and shapes of the device. Parallel to other studies, we used the new device for selected patients who were no optimal candidates for established techniques like neurosurgical clipping or endovascular coiling. We aimed to report the angiographic and clinical results of WEB implantations or combinations between WEB and coiling or intracranial stents. We reviewed the records of n = 23 interventions in 22 patients with unruptured wide-neck aneurysms (UIA) who were assigned for aneurysm treatment with the use of the WEB or adjunctive techniques. Interventional procedures and clinical and angiographic outcomes are reported for the periprocedural phase and in mid-term FU. Of the included 22 patients, six patients needed additional coiling, intracranial stenting, or implantation of a flow diverter. WEB implantation was technically feasible in 22 out of the 23 interventions. Follow-up angiographic imaging proved total or subtotal occlusion of the aneurysm in 19 of 22 cases. Two minor recurrences remained stable during a period of 15months. One patient with a partially thrombosed giant MCA aneurysm had a major recurrence and was retreated with a second WEB in combination with coiling. Despite of unfavorable anatomic conditions, broad-based and large UIA endovascular treatment with the WEB and adjunctive techniques was feasible with a low risk of complications and promising occlusion rates in mid-term follow-up.

WEB Treatment of Intracranial Aneurysms: Clinical and Anatomic Results in the French Observatory.

Flow disruption with the WEB device is a new technique for the endovascular treatment of wide-neck bifurcation aneurysms. To obtain precise data regarding the safety and efficacy of this treatment with high-quality methodology, the prospective French Observatory study was conducted. Analysis of these data is presented, including 1-year follow-up. Patients with bifurcation aneurysms for which WEB treatment was indicated were included in this prospective, multicenter Good Clinical Practice study. Clinical data, including adverse events and clinical status at 1 month and 1 year, were collected and independently analyzed by a medical monitor. An independent core laboratory evaluated the anatomic results at 1 year following the procedure. Ten French neurointerventional centers included 62 patients (39 women), 33-74 years of age (mean, 56.6 ± 9.80 years) with 63 aneurysms. Aneurysm locations were the middle cerebral artery in 32 aneurysms (50.8%), anterior communicating artery in 16 (25.4%), basilar artery in 9 (14.3%), and internal carotid artery terminus in 6 (9.5%). Morbidity and mortality at 1 month were, respectively, 3.2% (2/62 patients) and 0.0% (0/62). Morbidity and mortality (unrelated to the treatment) at 1 year were, respectively, 0.0% (0/59) and 3.4% (2/59 patients). At 1 year, complete occlusion was observed in 30/58 aneurysms (51.7%); neck remnant, in 16/58 aneurysms (27.6%); and aneurysm remnant, in 12/58 aneurysms (20.7%). This prospective French Observatory study showed very good safety of aneurysm treatment with the WEB, with a high rate of adequate aneurysm occlusion at 1 year (79.3%).

WEB-DL Endovascular Treatment of Wide-Neck Bifurcation Aneurysms: Long-Term Results in a European Series.

Flow disruption with the WEB-DL device has been used safely for the treatment of wide-neck bifurcation aneurysms. The stability of aneurysm occlusion after this treatment was evaluated in the short and midterm, but not in the long term. This retrospective multicenter European study is the continuation of an already published series dealing with short- and midterm anatomic results and analyzes long-term data in patients treated with the WEB-DL. Twelve European neurointerventional centers initially participated in the study. In addition to data collected for the initial publication, images obtained at long-term follow-up were collected and independently analyzed by the same experienced interventional neuroradiologist. Of the initial 45 patients, 26 (20 women and 6 men; 35-73 years of age; mean, 55.2 ± 10.6 years; median, 55.5 years) with 26 aneurysms treated with the WEB-DL device had long-term follow-up (median, 27.4 months). Three of 26 patients (11.5%) were retreated between short- and midterm follow-up, and none, between mid- and long-term follow-up. Long-term aneurysm occlusion in the 19 patients treated with the WEB only and not retreated during follow-up was complete occlusion in 13/19 patients (68.4%), including aneurysms with opacification of the proximal recess in 9/19 patients (47.4%), neck remnant in 3/19 patients (15.8%), and aneurysm remnant in 3/19 patients (15.8%). In all patients (100.0%), aneurysm occlusion was stable between midterm and long-term follow-up. The results suggest that WEB treatment of wide-neck bifurcation aneurysms offers long-term stable occlusion.

O-026 web endovascular treatment of wide-neck bifurcation aneurysms: long-term results in a european series

Purpose Flow disruption with the WEB-DL device has been used safely for the treatment of wide-necked bifurcation aneurysms. The stability of aneurysm occlusion after this treatment was evaluated in short- and midterm, but not in long-term. This retrospective multicenter European study is the continuation of an already published series dealing with short-and midterm anatomical results and analyzes long-term data in patients treated with WEB-DL. Methods Twelve European neurointerventional centers initially participated to the study. In addition to data collected for the initial publication, images obtained at long-term follow-up were collected and independently analyzed by the same experienced interventional neuroradiologist. Results Out of the initial 45 patients, 26 (20 females and 6 males) aged 35 to 73 years (mean: 55.2 +/- 10.6 years; median: 55.5 years) harboring 26 aneurysms treated with the WEB-DL device had long-term follow-up (median: 27.4 months). Three out of 26 patients (11.5%) were retreated between short- and midterm follow-up and none between mid- and long-term. Long-term aneurysm occlusion in the 19 patients treated with WEB only and not retreated during follow-up was complete occlusion in 13/19 patients (68.4%) including aneurysms with opacification of the proximal recess (9/19 patients, 47.4%), neck remnant in 3/19 patients (15.8%), and aneurysm remnant in 3/19 patients (15.8%). In all patients (100.0%), aneurysm occlusion was stable between midterm and long-term follow-up. Conclusions The results suggest that WEB treatment of wide-neck bifurcation aneurysms offers long-term stable occlusion. Disclosures L. Pierot: 2; C; Sequent. J. Klisch: 2; C; Sequent. T. Liebig: 2; C; Sequent. J. Gauvrit: None. M. Leonardi: None. N. Nunzi: None. F. Di Paola: None. V. Sychra: None. B. Mine: None. B. Lubicz: None.

O-027 the barrel vrd™ vascular reconstruction device for the treatment of wide-neck bifurcation aneurysms

Purpose Complex wide-necked bifurcation aneurysms by using a single-stent and double (X and Y) stenting remain challenging. The purpose of the French Barrel VRD™ Prospective Registry, an intention to treat study, was to evaluate the safety and probable benefit of the device when used to facilitate endovascular coiling of wide-neck bifurcating aneurysms. Methods The Barrel VRD™ was intended for use with embolic coils for the treatment of wide-neck bifurcating intracranial aneurysms arising from a parent vessel with a diameter of ≥ 2 mm and ≤ 4 mm. A wide-neck is defined as having a neck width ≥ 4 mm or a dome-to-neck ratio Results Twenty patients harboring 20 bifurcation aneurysms (8 MCA, 4 basilar tip, 4 AcoA, 4 ICA termination) were enrolled within the French Barrel Registry. One patient was enrolled, but not treated due to being a low anti-platelet responder. Patient enrollment was completed on December 2014. Aneurysm necks ranged from 3.1 to 8.0 mm (mean: 5.6) and dome/neck ratio ranged from 0.6 to 1.9 (mean: 1.2). All but 2 aneurysms were virgin unruptured aneurysms, 2 aneurysms were recurring aneurysms after previous endovascular treatment. Trans-cell microcatheter placement was obtained in all cases. Technical success was 100% (19/19). The mean overall performance of the device was 3.1 (on a 0 to 5 scale). Discharge mRS was 0 for all but 1 patient (this patient was mRS 2 at admission). Four serious adverse events were deplored in 3 patients: an ischemic stroke ipsilateral to the stent following low blood pressure after orthopedic surgery 9 months after stent implantation (mRS 3), a SAH during procedure due to perforation of the dome with the coil delivery microcatheter (mRS 0), a groin hematoma requiring prolonged hospital stay and transfusion, a pseudo-aneurysm of the femoral artery requiring surgical repair. At the end of the procedure, Raymond grade 1 occlusion was obtained in 9 cases, grade 2 in 5 cases, and grade 3 in 5 cases. To date, one-year angiographic follow-up was obtained in 5 (25.0%) patients, showing Raymond grade 1 occlusion in 3/5, grade 2 in 1/5, grade 3 in 1/5. There were neither parent vessel occlusion nor stenosis. Conclusions The results demonstrate that the Barrel VRD device is new, effective tool for the endovascular treatment of wide neck bifurcation aneurysms. The main advantage of the Barrel VRD™ is to avoid the use of 2 stents in a Y-configuration for bifurcation aneurysm neck reconstruction. Disclosures M. Piotin: 2; C; Covidien, Microvention, Stryker. 4; C; Lazarus Effect. J. Berge: None. F. Turjman: None. R. Blanc: None.

O-021 safety and efficacy of web®aneurysm treatment: combined analysis of webcast and french observatory studies

Purpose WEB Flow disruption is an innovative endovascular treatment for wide-neck bifurcation aneurysms. Two prospective multicenter GCP (Good Clinical Practice) studies were conducted in Europe and inclusions were completed in February 2014 in both trials. Safety and efficacy data are analyzed. Methods Patients with wide neck bifurcation aneurysms were included in both WEBCAST and French Observatory. An independent medical monitor independently analyzed adverse events. Follow-up imaging was obtained at 6 and 12 months in WEBCAST study and at 12 months in French Observatory. An independent expert in Interventional Neuroradiology evaluated anatomical results using the 3 grades scale: complete occlusion, neck remnant, and aneurysm remnant. In WEBCAST, the reader was also directly comparing evolution of anatomical results between 6 months and 12 months classified as improved, stable, or worsened. Results A total of 113 patients (74 females, 65.5%) with 114 aneurysms (10 ruptured, 8.8%; 99 unruptured, 88.8%; and 5 recanalized, 4.4%) were included in both studies (51 in WEBCAST and 62 in French Observatory). Fifty-nine aneurysms were located at middle cerebral artery (51.8%), 22 at anterior communicating artery (19.3%), 21 at basilar artery (18.4%), and 12 at internal carotid artery terminus (10.5%). Morbidity and mortality at one month were respectively 2.7% and 0.0%. Twelve months imaging follow-up will be completed in 2015, is currently under analysis, and will be presented as well as evolution of aneurysm occlusion between 6 and 12 months in WEBCAST. Conclusion This analysis confirms the safety of WEB treatment. Efficacy data will be presented. Disclosures L. Pierot: 2; C; Sequent. A. Molyneux: 2; C; Sequent. J. Byrne: 2; C; Sequent.

E-044 web-sl/sls®aneurysm treatment: one-month safety results in webcast2 study

Purpose WEB flow disruption is an innovative endovascular treatment for wide-neck bifurcation aneurysms. WEBCAST1 analyzed the safety and efficacy of the WEB-DL device. WEBCAST2 is dedicated to the safety and efficacy analysis of the WEB-SL and WEB-SLS device. Methods WEBCAST2 is a prospective, multicenter, European study involving 13 Interventional Neuroradiology centers. Patients with bifurcation aneurysms are included in WEBCAST2. Aneurysm locations included in WEBCAST2 are middle cerebral artery, internal carotid artery terminus, anterior communicating artery, posterior communicating artery, and basilar tip. Patients with ruptured and unruptured aneurysms are included. All adverse events are collected and will be analyzed by an independent medical monitor. Morbidity and mortality will be analyzed at 1, 6, and 12 months. Follow-up imaging will be obtained at 6 and 12 months and up to 5 years, and independently analyzed by an expert in Interventional Neuroradiology. The goal is to enroll up to 60 patients. An intermediate analysis will be conducted after inclusion of 50 patients. Results Inclusions started in August 2014. As of March 9, 43 patients were included. The expectation is to have 50 evaluable patients included end of May. One-month clinical follow-up will be completed end of June. One-month safety data will be presented and analyzed in comparison with other WEB Good Clinical Practice (GCP) Data (WEBCAST1 and French Observatory that included patients treated with both WEB-DL and WEB-SL/SLS). Conclusion WEBCAST2 is an ongoing study evaluating WEB-SL/SLS aneurysm treatment. Inclusion completion is expected end of May. One-month safety data will be presented and analyzed in light of previous GCP studies (WEBCAST1 and French Observatory). Disclosures L. Pierot: 2; C; Sequent. A. Molyneux: 2; C; Sequent. J. Byrne: 2; C; Sequent. W. Investigators: None.

Hybrid, Y-configured, dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms.

In Y-stenting, stabilization of the first stent may be problematic as in some cases it migrates during second stent insertion. This report evaluates the safety and effectiveness of the technique and presents the long-term results of hybrid, Y-configured, dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms. We retrospectively evaluated the patients treated endovascularly due to cerebral aneurysms. Twenty patients treated with hybrid Y-stent-assisted coil embolization were enrolled in the study. In hybrid stenting, an open-cell intracranial stent (Neuroform) was used as a first stent to prevent stent migration. A closed-cell stent (Enterprise or Acclino) was used as a second stent and the aneurysm was embolized with coils between the stent struts. In all patients, hybrid Y-stenting and coil embolization were accomplished successfully. No stent migration occurred. Clinically, neither symptomatic neurologic complication nor death was seen. Of 20 wide-necked bifurcation aneurysms, nine were at the basilar tip, while seven were at the middle cerebral artery and three at the anterior communicating artery. In one patient, the aneurysm was at the A2-3 junction of the anterior cerebral artery. One of the patients had a subarachnoid hemorrhage. The mean angiographic follow-up was 25.6 months. No in-stent stenosis was seen in any of the patients and recanalization in only one. Hybrid, Y-configured, dual stent-assisted coil embolization is a safe and effective method in the treatment of wide-necked bifurcation aneurysms to prevent stent migration and aneurysm recanalization, and is a viable alternative to microsurgery.

Abstract W P86: The Barrel Vascular Reconstruction Device for the Treatment of Wide-Neck Bifurcation Aneurysms

PURPOSE: Complex wide-necked bifurcation aneurysms by using a single-stent and double (X and Y) stenting remain challenging. The purpose of the French Barrel™ Prospective Registry, an intention to treat study, is to evaluate the safety and probable benefit of the Barrel VRD when used to facilitate endovascular coiling of wide-neck bifurcating. METHODS: The Barrel VRD was intended for use with embolic coils for the treatment of wide-neck bifurcating intracranial aneurysms arising from a parent vessel with a diameter of ≥ 2mm and ≤ 4 mm. A wide-neck is defined as having a neck width ≥ 4 mm or a dome-to-neck ratio &lt; 2. Patients (all harboring unruptured aneurysms) were placed on a double anti-platelet protocol (Clopidogrel and ASA) prior to treatment. RESULTS: From December 2013 to June 2014, 18 patients harboring 18 aneurysms (7 MCA, 4 basilar tip, 4 AcoA, 3 ICA termination) were enrolled within the French Barrel Registry thus far. One patient was enrolled, but not treated due to being a low anti-platelet responder. Aneurysm necks ranged from 3.1 to 8.0 mm (mean: 4.8) and dome/neck ratio ranged from 0.6 to 1.7 (mean : 1.2). Trans-cell microcatheter placement was obtained in all cases. Technical success was 88.2% (15/17). In 1 case, 2 coil loops protruded outside the Barrel within the parent vessel, in another case the Barrel moved slightly during coil delivery microcatheter placement into the sac. Discharge mRS was 0 for all but 1 patients (this patient was mRS 2 at admission). Adverse events included 1 groin hematoma, and 1 aneurysm coil perforation, related to the procedure, but not the Barrel VRD. CONCLUSIONS: The initial French Barrel Registry results demonstrate that the Barrel VRD device is new tool for the endovascular treatment of wide neck bifurcation aneurysms.

Hybrid, Y-Configured, Dual Stent-Assisted Coil Embolization in the Treatment of Wide-Necked Bifurcation Aneurysms

Hybrid, Y-Configured, Dual Stent-Assisted Coil Embolization in the Treatment of Wide-Necked Bifurcation Aneurysms

Y-stent assisted coiling of bifurcation aneurysms with Enterprise stent: long-term follow-up

BackgroundY-stent assisted coiling has been proposed for the treatment of wide-neck bifurcation aneurysms, but there are many technical variations. We report our single-center experience of Y-stent assisted coiling of bifurcation...

P-009 WEB Endovascular Treatment of Wide-neck Bifurcation Aneurysms: Short- and Midterm Results in a European Study

Background and purposeFlow disruption with the WEB-DL device has been used safely for the treatment of wide-necked bifurcation aneurysms but the stability of aneurysm occlusion after this treatment is unknown....

Abstract W P69: Y and X Stent-Assisted Coiling of Complex and Wide-Neck Bifurcation Aneurysms in 100 Procedures

Purpose: Stent-assisted coiling with two stents in Y or X configuration has been described in some series for the treatment of complex and wide-neck bifurcation aneurysms. Our purpose is to present our experience with double stents in “X” and “Y” configurations, with emphasis on safety, feasibility and efficacy. Methods: Clinical and angiographic outcomes of patients for whom the strategic therapeutic chosen option was the stent-assisted coiling technique in “Y” and “X” fashion to reconstruct the neck from June 2006 to June 2013, were retrospectively analyzed from our prospectively gathered database. Results: One hundred and five aneurysms in 97 patients were treated during 100 consecutive procedures. There were 54.2% (57/105) MCA, 28.6% (30/105) AcoA, 16.2% (17/105) basilar tip and 1.0% (1/105) ICA termination aneurysms. Clinical presentations were: incidental discovery 75.2% (79/105), compression 1.0% (1/105), recurrences of previously coiled aneurysms 19.0% (20/105), SAH 4.7% (5/105). A “Y” stenting was used to treat 87 aneurysms in 85 procedures; a “X” stenting was used to treat 7 aneurysms in 6 procedures, while 9 procedures failed for 11 aneurysms. Permanent neurological deficits were noted in 11.0% (11/100) of the procedures, including 1 death. Immediate complete occlusions were noted in 47.6% (50/105) of the aneurysms, partial (neck or sac remnant) occlusions in 52.4% (55/105). To date, 74.3% (78/105) of the aneurysms had been followed up (mean: 16 months) with DSA, disclosing a recanalization in 4.8% (5/105), and an improvement in 34.3% (36/105). No aneurysm (re)bled during the follow-up period. Conclusions: “Y” and “X” stent-assisted coiling of complex bifurcation intracranial aneurysms is a feasible and effective technique for endovascular treatment of wide-neck bifurcation aneurysms. However, we encountered a high rate of complications with permanent neurological deficits. Improvement of stent design and newer antiplatelet drugs may improve the procedural safety in the future.