Safety and efficacy of stent-assisted coiling for acutely ruptured wide-necked intracranial aneurysms: comparison of LVIS stents with laser-cut stents

Gaici Xue,Qiao Zuo,Xiaoxi Zhang,Qinghai Huang,Yibin Fang,Qiang Li,Rui Zhao,Bo Hong,Pengfei Yang,Haishuang Tang,Jianmin Liu,Yi Xu

doi:10.1186/s41016-021-00237-1

Abstract

BackgroundTo compare the safety and efficacy of LVIS stent-assisted coiling with those of laser-cut stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms.MethodsPatients with acutely ruptured wide-necked intracranial aneurysms treated with LVIS stent-assisted coiling (LVIS stent group) and laser-cut stent-assisted coiling (laser-cut stent group) were retrospectively reviewed from January 2014 to December 2017. Propensity score matching was used to adjust for potential differences in age, sex, aneurysm location, aneurysm size, neck width, Hunt-Hess grade, and modified Fisher grade. Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared. Univariate and multivariate analyses were performed to determine the associations between procedure-related complications and potential risk factors.ResultsA total of 142 patients who underwent LVIS stent-assisted coiling and 93 patients who underwent laser-cut stent-assisted coiling were enrolled after 1:2 propensity score matching. The angiographic follow-up outcomes showed that the LVIS stent group had a slightly higher complete occlusion rate and lower recurrence rate than the laser-cut stent group (92.7% vs 80.6%; 3.7% vs 9.7%, P = 0.078). The clinical outcomes at discharge and follow-up between the two groups demonstrated no significant differences (P = 0.495 and P = 0.875, respectively). The rates of intraprocedural thrombosis, postprocedural thrombosis, postoperative early rebleeding, and procedure-related death were 0.7% (1/142), 1.4% (2/142), 2.8% (4/142), and 2.1% (3/142) in the LVIS stent group, respectively, and 4.3% (4/93), 2.2% (2/93), 1.1% (1/93), and 3.2% (3/93) in the laser-cut stent group, respectively (P = 0.082, 0.649, 0.651, and 0.683). Nevertheless, the rates of overall procedure-related complications and intraprocedural rupture in the LVIS stent group were significantly lower than those in the laser-cut stent group (5.6% vs 14.0%, P = 0.028; 0.7% vs 6.5%, P = 0.016). Multivariate analysis showed that laser-cut stent-assisted coiling was an independent predictor for overall procedure-related complications (OR = 2.727, P = 0.037); a history of diabetes (OR = 7.275, P = 0.027) and other cerebrovascular diseases (OR = 8.083, P = 0.022) were independent predictors for ischemic complications, whereas none of the factors were predictors for hemorrhagic complications.ConclusionsCompared with laser-cut stent-assisted coiling, LVIS stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms could reduce the rates of overall procedure-related complications and intraprocedural rupture.

Highlights

To compare the safety and efficacy of low-profile visualized intraluminal support (LVIS) stent-assisted coiling with those of laser-cut stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms
Compared with laser-cut stent-assisted coiling, LVIS stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms could reduce the rates of overall procedure-related complications and intraprocedural rupture
According to the inclusion and exclusion criteria, the clinical and angiographic data of 349 patients with widenecked acutely Ruptured intracranial aneurysms (RIA) treated with SAC were retrospectively reviewed by 2 experienced neurologists between January 2014 and December 2017, including 235 patients treated with LVIS stent-assisted coiling (LVIS stent group) and 114 patients treated with laser-cut stentassisted coiling

Summary

Introduction

To compare the safety and efficacy of LVIS stent-assisted coiling with those of laser-cut stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms. A growing number of studies have corroborated that stent-assisted coiling (SAC) improved the long-term outcomes of unruptured wide-necked intracranial aneurysms compared with balloon-assisted coiling or coiling only, without significantly increasing the risk of perioperative procedurerelated complications [5,6,7,8]. For acutely ruptured intracranial aneurysms (RIAs), the perioperative safety of stent placement has been highly controversial [9,10,11]. Several recent studies have shown that SAC did not increase the risk of perioperative procedure-related complications for the treatment of selected wide-necked acutely RIAs [18,19,20,21,22]. The inconsistency of the results of these studies may be substantially attributed to the differences in periprocedural antiplatelet medication management, types of stents, operator experience and skills, and criteria for the selection of cases [6]

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Conclusion