Extended Follow-Up Analysis of Intracranial Bifurcation Aneurysms Managed with Braided Stent-Assisted Coil Embolization: A Single-Center Experience

Year 2026, Volume: 53 Issue: 1, 31 - 37, 10.03.2026

Özgür Zülfükar Ertuğrul , Fırat Karaaslan

https://doi.org/10.5798/dicletip.1906394

https://izlik.org/JA36XW88RY

Abstract

Objective: This study retrospectively analyzed clinical and angiographic follow-up data of patients who underwent braided stent-assisted coil embolization for intracranial bifurcation aneurysms in a single-center series.
Methods: Between July 2023 and September 2025, 90 patients with unruptured intracranial bifurcation aneurysms were treated with braided stent-assisted coil embolization. Wide-neck aneurysms were defined as those with a neck diameter >4 mm or a dome-to-neck ratio <2 (1). All patients received dual antiplatelet therapy and underwent follow-up digitalsubtraction angiography (DSA) at 6 and 12 months, and magnetic resonance angiography (MRA) at 24 months. Thedegree of occlusion was evaluated according to the Roy–Raymond Occlusion Classification (RROC) (2).
Results: The mean age was 59.9 years (range 28–79), and 48% of patients were female. Aneurysm locations were anterior communicating artery (n=38), middle cerebral artery (n=31), and basilar tip (n=21). All procedures were completed successfully with no technical failures. Periprocedural complications occurred in 3.3% of cases, all transient and without permanent morbidity. Complete occlusion (RROC Grade 1) increased from 35.6% immediately post-procedure to 84.4% at 24 months. Seven patients required retreatment with flow-diverter stents beyond 24 months due to residual aneurysm filling (3,4).
Conclusion: Braided stent-assisted coil embolization is a reliable endovascular approach for treating intracranial bifurcation aneurysms. It demonstrates high procedural success, low complication rates, and progressive aneurysm occlusion during follow-up. The shelf and mild flow-diverting effects of braided stents contribute to durable long-term results, particularly in wide-neck and complex aneurysms.

Keywords

Intracranial aneurysm , braided stent , coil embolization , bifurcation aneurysm , endovascular treatment

Ethical Statement

Ethical approval for this study was obtained from the Clinical Research Ethics Committee of Gazi Yaşargil Training and Research Hospital, University of Health Sciences (Date: 24.10.2025, Decision No: 676).

Örgülü Stent Destekli Koil Embolizasyonu ile Tedavi Edilen İntrakraniyal Bifurkasyon Anevrizmalarının Uzun Dönem Takip Analizi: Tek Merkez Deneyimi

https://izlik.org/JA36XW88RY

Abstract

Amaç: Bu çalışmada örgülü stent destekli koil embolizasyonu ile tedavi edilen intrakraniyal bifurkasyon anevrizmalarının uzun dönem klinik ve anjiyografik sonuçları retrospektif olarak değerlendirildi.
Yöntemler: Temmuz 2023 – Eylül 2025 tarihleri arasında, rüptüre olmamış intrakraniyal bifurkasyon anevrizması bulunan 90 hasta örgülü stent destekli koil embolizasyon yöntemiyle tedavi edildi. Geniş boyunlu anevrizma, boyun çapı >4 mm veya kubbe-boyun oranı <2 olarak tanımlandı (1). Tüm hastalara çiftli antiplatelet tedavi uygulandı ve 6. ile 12.aylarda DSA, 24. ayda MRG anjiyografi ile takip yapıldı. Oklüzyon durumu Roy–Raymond sınıflamasına göredeğerlendirildi (2).
Bulgular: Ortalama yaş 59,9 (28–79) olup hastaların %48’i kadındı. Anevrizma yerleşimleri: ACoA (n=38), MCA (n=31), baziler tepe (n=21). Tüm olgularda teknik başarı sağlandı. %3,3 oranında, tamamı geçici olmak üzere işlem sırasında komplikasyon izlendi. Tam oklüzyon oranı (RROC Grade 1) işlem sonrası %35,6 iken, 24. ayda %84,4’e yükseldi. Yedi hasta, 24. ay sonrası rezidü nedeniyle flow-diverter stent ile yeniden tedavi edildi (3,4).
Sonuç: Örgülü stent destekli koil embolizasyonu, intrakraniyal bifurkasyon anevrizmalarının tedavisinde güvenli, etkili ve uzun vadede başarılı bir yöntemdir. Özellikle geniş boyunlu ve kompleks yapılı anevrizmalarda “shelf” etkisi ve akım yönlendirici özellikleriyle uzun dönem oklüzyon başarısını desteklemektedir.

Keywords

İntrakraniyal anevrizma , örgülü stent , koil embolizasyonu , bifurkasyon anevrizması , endovasküler tedavi.

References

• 1.Pierot L, Spelle L, Vitry F; ATENA Investigators.Immediate clinical outcome of patients harboringunruptured intracranial aneurysms treated byendovascular approach: results of the ATENA study.Stroke. 2008.
• 2.Roy D, Raymond J, et al. Endovascular treatmentof unruptured intracranial aneurysms: clinical andangiographic outcome. Stroke. 2001.
• 3.Alturk AY, Nicholson P, Srinivasan VM, et al.Retreatment with flow diverters and coiling forrecurrent aneurysms after initial endovascular treatment: a propensity score-matched comparative analysis. Front Neurol. 2021;12:625652.
• 4.Feng X, Liu P, Zhang Y, Li Y, Zhang J, Wang K, et al.Efficacy and safety of flow diverters in retreatmentof recurrent or residual intracranial aneurysms: asystematic review and meta-analysis. Front Neurol.2025;16:1155976.
• 5.Aydin K, Arat A, Sencer S, et al. The “shelftechnique” using a low-profile braided stent in theendovascular treatment of wide-necked bifurcationaneurysms. Neurosurgery. 2019.
• 6.Wang F, Zhang Y, et al. Safety and efficacy of LVISstent-assisted coil embolization in intracranialwide-necked bifurcation aneurysms. Front Neurol.2022.
• 7.Songsaeng D, Geibprasert S, et al. Shelf techniqueusing LVIS stent for wide-neck bifurcationaneurysms. Interv Neuroradiol. 2020.
• 8.Martínez-Galdámez M, Lamin SM, et al.Endovascular treatment of intracranial aneurysmsusing LEO stents: a multicenter experience. JNeurointerv Surg. 2017.
• 9.Neki H, Ryu K, et al. Use of braided stents for thetreatment of bifurcation aneurysms: technicalaspects and midterm follow-up. Clin Neuroradiol.2021.
• 10.Oishi H, Yamamoto M, et al. Usefulness of LVISstent for wide-neck intracranial aneurysms.Neurosurgery. 2018.
• 11.Cho SH, et al. Long-term outcomes of stent-assisted coil embolization for wide-neckedaneurysms: a single-center experience. J Neurosurg.2021.
• 12.Martínez-Galdámez M, Lamin SM, et al.Endovascular treatment of intracranial aneurysmsusing LEO stents: a multicenter experience. J Neurointerv Surg. 2017.
• 13.Aydin K, Arat A, Sencer S, et al. The “shelftechnique” using a low-profile braided stent in theendovascular treatment of wide-necked bifurcationaneurysms. Neurosurgery. 2019.
• 14.Neki H, Ryu K, et al. Use of braided stents for thetreatment of bifurcation aneurysms: technicalaspects and midterm follow-up. Clin Neuroradiol.2021.
• 15.Möhlenbruch MA, Herweh C, et al. The LVIS Jr.device for the treatment of intracranial aneurysms:clinical experience with 100 aneurysms. Eur Radiol.2017.
• 16.Cagnazzo F, et al. Flow-diversion versus stent-assisted coiling for treatment of unrupturedbifurcation aneurysms: a meta-analysis. AJNR Am JNeuroradiol. 2019.
• 17.Dmytriw AA, Phan K, et al. Flow diversion forbifurcation aneurysms: a meta-analysis. AJNR Am JNeuroradiol. 2019.
• 18.Aydin K, et al. Endovascular treatment ofcomplex bifurcation aneurysms using braidedstents. Interv Neuroradiol. 2020.
• 19.Bender MT, et al. Comparison of flow diversionand stent-assisted coiling in small bifurcationaneurysms. Neurosurgery. 2020.
• 20.Brinjikji W, et al. Antiplatelet therapy andoutcomes following stent-assisted coiling ofcerebral aneurysms. AJNR Am J Neuroradiol. 2015.
• 21.Hanel RA, Lopes DK, et al. Thromboemboliccomplications after stent-assisted coil embolizationof cerebral aneurysms: risk factors and prevention.J Neurointerv Surg. 2014.