The "Y"-configuration of double Neuroform Atlas assisted coil embolization for treatment of cerebral bifurcation wide-neck aneurysms: very long-term follow-up of a multicentric experience

Aim: Endovascular treatment of cerebral bifurcation wide-neck aneurysms remains a therapeutic challenge in terms of safety profile and timely treatment efficacy. The aim of this study is to investigate the very long-term efficacy and safety of Y stenting-assisted coiling with Neuroform Atlas in the treatment of wide-neck bifurcation aneurysms. Methods: Clinical, procedural and follow-up data were analyzed to evaluate the safety and effectiveness of the treatment with Y-stenting assisted coil strategy (with Neuroform Atlas) in wide-neck bifurcation aneurysms. Endovascular technical aspects were also investigated. Morbidity and mortality were recorded. Digital subtraction angiography (DSA) for mid-term follow-up (12-15 months) and MR-angiography (MRA) for long-term follow-up (24-36 months) and very long-term follow-up (48-60 months) were evaluated in order to assess the efficacy. Results: The study included 21 Patients (12 Females, 9 Males) aged between 41 and 78 years, with a median age of 60 years. Of the aneurysms treated, 6 belonged to the middle cerebral artery bifurcation (MCA) (28.6%), 10 to the anterior communicating artery (AComA) (47.6%) and 5 to the basilar artery tip (BA) (23.8%). The median aneurysm size and dome/neck ratio were 5 and 1.2 mm, respectively. Technical success was achieved in all 21 cases (100%). No complication related to stent placement was observed. The morbidity rate was 9.5% (2/21) procedure-related; 1 case of intra-procedural SAH and 1 post-procedural stroke were observed. No death was observed. Mid-term DSA, according to the modified Raymond-Roy Occlusion Classification (RROC), showed 16 Class I (76.2%), 4 II(19%), and 1 IIIa (4.8%). Long-term MRA follow-up (24-36 months) showed aneurysm complete occlusion (CO) in 17 cases (80.9%) and residual neck (NR) in 4 cases (19.1%). Very long-term MRA follow-up (48-60 months) confirmed the same rate of occlusion (CO 80.9%; NR 19.1%). Long-term and very longterm MRA follow-up showed vessels' patency in all cases (100%). Conclusion: Y-stenting-assisted coil embolization represents a safe and effective technique demonstrating an adequate rate of aneurysm occlusion at long-term follow-up and very long-term follow-up.