Abstract
Introduction: Wide-necked intracranial aneurysms (IAs) are complex lesions that may require different microsurgical or endovascular strategies, and stent-assisted coiling (SAC) has emerged as a feasible alternative to treat this subset of aneurysms.Methods: The objective was to assess the rate of complications of unruptured wide-necked IAs treated with SAC. We retrospectively identified patients with unruptured wide-necked IAs treated with SAC. Medical charts, procedure reports, and imaging studies were analyzed.Results: One hundred twenty patients harboring 124 unruptured wide-necked IAs were included. Ninety-two aneurysms (74.2%) were located in the anterior circulation. The median aneurysm size was 7 mm (IQR = 5-10). The immediate complete aneurysm occlusion rate was 29% (36/124). The rate of procedural complications was 3.3 % (4/120), which included 2 intraprocedural aneurysm ruptures, 1 immediate postprocedure aneurysm rupture, and 1 vessel occlusion rescued with an open-cell stent. The median follow-up time was 21 months (IQR = 10.3-40.9). Kaplan-Meier analysis estimated a median time of complete aneurysm occlusion of 6.3 months (95%CI = 3.8-7.8). At 30-day follow-up, 80.7% of patients had a Glasgow Outcome Score (GOS) of 5 and at the latest follow-up 83.9%. Imaging follow-up was available for 102 patients. The rate of complete aneurysm occlusion was 73.5% (75/102), severe in-stent stenosis (>50%) was found in 1% (1/102), the recanalization rate was 6.6% (5/75), and the retreatment rate was 7.8% (8/102).Conclusion: SAC remains a safe and effective technique to treat wide-necked IAs, providing a low rate of complications and recanalization with excellent long-term aneurysm occlusion rates.
Highlights
Wide-necked intracranial aneurysms (IAs) are complex lesions that may require different microsurgical or endovascular strategies, and stent-assisted coiling (SAC) has emerged as a feasible alternative to treat this subset of aneurysms
We present our experience with SAC embolization in patients with unruptured wide-necked intracranial aneurysms at a high-volume center and assess the rate of procedure technical events, long-term aneurysm occlusion, in-stent stenosis, and retreatment
Our secondary outcomes were to assess the rate of complete aneurysm occlusion, in-stent stenosis, aneurysm recanalization, and retreatment based on the latest imaging follow-up available
Summary
Wide-necked intracranial aneurysms (IAs) are complex lesions that may require different microsurgical or endovascular strategies, and stent-assisted coiling (SAC) has emerged as a feasible alternative to treat this subset of aneurysms. Since the early 1990s, with the introduction of detachable coils by Guglielmi, neurovascular treatment of aneurysms has seen widespread development of improved techniques, How to cite this article Aguilar-Salinas P, Brasiliense L B, Santos R, et al (June 06, 2019) Safety and Efficacy of Stent-assisted Coiling in the Treatment of Unruptured Wide-necked Intracranial Aneurysms: A Single-center Experience. Stent-assisted coiling (SAC) was developed for aneurysms with a neck diameter of 4 mm or greater, to provide mechanical support and prevent coil prolapse into the lumen as well as a scaffold for endothelialization, facilitating aneurysm thrombosis [2,3,4,5]. Regardless of the SAC technique, reported complications include vessel perforation, thromboembolic events, in-stent stenosis, and hemorrhage
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