The Difficulties and Risks of Y-Stente-Assisted Coiling: A Comparison of First and Second Stenting Procedures

OBJECTIVE: Y-stent-assisted coiling (YSAC) requires multiple device accesses for double stenting. The purpose of this study was to test the hypothesis that second stenting procedures are riskier than first stenting procedures. METHODS: We retrospectively reviewed the medical records of 19 patients with 20 aneurysms undergoing YSAC. Difficulty was determined for each device when the difficulty number was >1. Procedure-based and device-based difficulties were compared between 2 stenting procedures. For second stenting procedures, stent-delivery-catheter difficulties (SDs) in passing through the struts of the first stent were assessed for 3 catheter types, 2 delivery methods, and 3 first-stent types. RESULTS: All YSACs were successful. Difficulties occurred more frequently with second stenting procedures than with first stenting procedures (procedure-based difficulties, 4 [20%] vs. 7 [35%], P = 0.29; device-based difficulties, 4 [9%] vs. 8 [18%], P = 0.19). In second stenting procedures, SDs occurred in 4 (20%) procedures and caused the midportion of the first stent to be bent into aneurysms in 2 of the procedures. Failures following difficulties were observed in only 2 (10%) second stenting procedures, necessitating other methods to complete procedures: 1 of the procedures had SD-related thrombosis leading to morbidity at discharge (modified Rankin Scale score 2). SDs were found only with 1 catheter type (4 of 15; PROWLER SELECT Plus) and 1 delivery method (4 of 15; direct over-the-wire) and not with the other catheter types (Rebar-18 or Excelsior 1018) and the other method (catheter-exchange). SDs were found most frequently with the use of the CODMAN ENTERPRISE stent in first stenting procedures (50%). CONCLUSIONS: In YSAC, second stenting procedures seem riskier than first stenting procedures, particularly when SDs occur. A proper device or delivery method may reduce the risks.