Long Term Efficacy of Y Stent Coiling for Bifurcation Aneurysms - A Systematic Review and Meta Analysis of 1,526 Patients

Introduction: Bifurcation aneurysms, located at cerebral artery branch points, are particularly challenging to treat due to their complex anatomy and high rupture risk. Y stent coiling, which involves placing two stents in a Y configuration to support coil placement, has shown promising results in the short term, offering high occlusion rates and low complication risks. However, long-term outcomes, including recurrence and stent durability, remain less understood. This systematic review and meta-analysis evaluate the long-term (>5 years) effectiveness and safety of Y stent coiling for bifurcation aneurysms, focusing on predictive factors like aneurysm size, location, and patient health that may impact these outcomes.

Methods: This systematic review followed PRISMA guidelines, searching PubMed, EMBASE, and Web of Science up to October 2024. A total of 1,403 papers were screened, with 20 studies meeting the inclusion criteria. All included studies had a mean follow-up duration of ≥24 months. Data extraction focused on recurrence, occlusion rates, complications, and patient demographics. Analysis was conducted in JMP, with subgroup comparisons based on follow-up duration, initial occlusion rates, and complication rates.

Results: A total of 20 studies comprising 1,526 patients were analyzed, with a median follow-up duration of 27 months (IQR: 24.85–38.58). Using the Wilcoxon and Kruskal-Wallis tests, statistically significant differences were noted. Patients in higher recurrence rate groups had lower follow-up partial occlusion rates (p = 0.0086), and higher recurrence rates were linked to increased complications (p < 0.0001). The Wilcoxon test further confirmed the association between higher recurrence rates and greater complication counts (z = 2.84977, p = 0.0044). These findings emphasize the substantial impact of recurrence rates on long-term occlusion and complication outcomes.

Conclusion : Recurrence rates significantly affect follow-up occlusion and complication outcomes, highlighting the need for vigilant monitoring and tailored patient management. Further research should explore more predictive markers and strategies to enhance the long-term effectiveness of Y stent coiling.