Abstract
Stent-assisted coiling has expanded the treatment of intracranial aneurysms. With the use of continuously compiled data, we reviewed the role and drawbacks of stent-assisted coiling. We compiled data from consecutive patients from 2003-2012 who underwent coiling, with or without stent assistance. Clinical and angiographic results were analyzed retrospectively. Of 1815 saccular aneurysms in 1505 patients, 323 (17.8%) were treated with stents (299 procedures) and 1492 (82.2%) without stents (1400 procedures). Procedure-related complications occurred in 9.4% with stents versus 5.6% without stents (P = .016, relative risk 1.5; 95% CI, 1.1-2.7). Ischemic complications were more frequent in the stent group than in the no-stent group (7.0% versus 3.5%; P = .005; relative risk, 1.7; 95% CI 1.2-2.5), as were hemorrhagic complications (2.3% versus 1.9%, P = .64). Procedure-induced mortality occurred in 2.7% (8/299) with stents versus 1.1% (15/1400) without stents (P = .029; relative risk, 2.0; 95% CI, 1.1-3.5). Logistic regression analysis identified wide-neck aneurysms as the most significant independent predictor of complications. A total of 64.1% (207/323) of aneurysms treated with stents and 70.3% (1049/1492) treated without stents have been followed, disclosing angiographic recurrence in 15.5% (32/207) versus 35.5% (372/1049), respectively (P < .0001). Logistic regression analysis showed that the presence of a stent was the most important factor for the reduction of angiographic recurrence (P < .0001; relative risk, 2.3; 95% CI, 1.6-3.3). The stent-assisted coiling technique is associated with a significant decrease in recurrences but a significant increase in complications. The treatment of wide-neck aneurysms remains hazardous.
Highlights
BACKGROUND AND PURPOSEStent-assisted coiling has expanded the treatment of intracranial aneurysms
The stent-assisted coiling technique has broadened the indication for coil embolization, and numerous reports have depicted the value of stents in the treatment of cerebral aneurysms.[1,2,3,4,5,6]
We present the clinical and angiographic results of a consecutive series of 1815 aneurysms treated over a 9-year period
Summary
Baseline Demographics and Procedures Among 1505 consecutive patients, 1815 intracranial aneurysms were treated by coil embolization in 1699 procedures. Risk Factors for Angiographic Recurrence In the univariate analysis, the risk factors for angiographic recurrence were ruptured status at presentation, larger aneurysm size, no stent, wider neck, younger age, and lower coil packing attenuation (Table 4). In the logistic regression analysis, the independent variables were ruptured status at presentation, absence of stent, larger aneurysm size, lower packing attenuation, younger age, and wider neck (Table 4). Analysis variables favoring retreatment were larger aneurysm size, absence of of variance followed by Bonferroni post hoc testing was used to stent, hemorrhagic presentation, lower packing attenuation, and initial assess differences between the stent-assisted and no-stent groups. The risk factors for procedure-related complications were wider neck, stent-assisted coiling, MCA location, and larger aneurysm. Stent-assisted coiling and aneurysm size were related to neck width (Table 7). Nineteen rebleedings occurred after coil embolization of 729 ruptured aneurysms (2.6%) and led to 13 deaths
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