Stent-Assisted Coiling of Bifurcation Aneurysms May Improve Endovascular Treatment: A Critical Evaluation in an Experimental Model

Surgical construction of aneurysms. The dysplastic bifurcation is constructed by creating a front and a back flap (A). Points AF are sutured together at the back, while the front flap is closed by suturing point C to AF and D to D′, resulting in a wide-neck bifurcation aneurysm (B). An example is shown at angiography in C.

Stent compaction and porosity. In vitro studies showing the effects of stent compaction on different segments or zones of stents when extremities are inserted in 2-mm tubes. Effects on stent 1 are shown in A, on stent 2 in B. While the porosity of Zone₃ can be significantly decreased with stent compaction, the transition Zone₂ remains relatively unchanged.

Endovascular treatment groups. Selected frames of angiographic series showing aneurysms before (A,E,I,M), immediately after (B,F,J,N), and 3 months after treatment (C,G,K,O), and photographs of the aneurysm ostium (D,H,L,P) in animals treated by coiling (A–D), single stent–assisted coiling (E–H), Y-stent-assisted coiling (I–L), and Y-stenting (M–P) showing recurring aneurysm with simple coiling (asterisk in C), better results with stent-assisted coiling, and the absence of therapeutic effect with Y-stenting only (asterisk in O). N was taken at the end of the angiographic series, to show the Y disposition of stents.