Stent-Assisted Coiling of Intracranial Aneurysms

TLDR

Stent‑assisted coiling has broadened intracranial aneurysm treatment, yet the rates of procedure‑related neurological complications and angiographic recurrence remain poorly characterized. This study reports the authors’ experience with stent‑assisted coiling, emphasizing procedure‑related neurological complications and angiographic recurrence. The authors retrospectively analyzed clinical and angiographic outcomes of 1137 consecutive patients (1325 aneurysms) treated from 2002 to 2009, comparing 216 stent‑assisted cases with 1109 non‑stent cases. Stent‑assisted coiling was linked to a lower angiographic recurrence rate (14.9% vs 33.5%) but higher rates of lethal complications (4.6% vs 1.2%) and non‑significant increases in permanent neurological complications (7.4% vs 3.8%).

Abstract

Background and Purpose— Stent-assisted coiling has expanded the treatment of intracranial aneurysms, but the rates of procedure-related neurological complications and the incidence of angiographic aneurysm recurrence of this novel treatment are not yet well known. We present our experience with stent-assisted coiling with special emphasis on procedure-related neurological complications and incidence of angiographic recurrence. Methods— Clinical and angiographic outcomes of 1137 consecutive patients (1325 aneurysms) coiled with and without stent-assisted coiling technique from January 2002 to January 2009 were retrospectively analyzed. Results— There were 1109 aneurysms (83.5%) treated without and 216 (16.5%) treated with stents (15 of 216; 6.9% balloon-expandable versus 201 of 216; 93.1% self-expandable stents). Stents were delivered after coiling in 55.1% (119 of 216) and before coiling in 44.9% (97 of 216) of the cases. Permanent neurological procedure-related complications occurred in 7.4% (16 of 216) of the procedures with stents versus 3.8% (42 of 1109) in the procedures without stents (logistic regression P =0.644; OR: 1.289; 95% CI: 0.439 to 3.779). Procedure-induced mortality occurred in 4.6% (10 of 216) of the procedures with stents versus 1.2% (13 of 1109) in the procedures without stents (logistic regression P =0.006; OR: 0.116; 95% CI: 0.025 to 0.531). A total of 52.7% (114 of 216) of aneurysms treated with stents have been followed so far versus 69.8% (774 of 1109) of aneurysms treated without stents, disclosing angiographic recurrence in 14.9% (17 of 114) versus 33.5% (259 of 774), respectively (Fisher exact test P <0.0001; OR: 0.3485; 95% CI: 0.2038 to 0.5960). Conclusions— Stents were associated with a significant decrease of angiographic recurrences, but they were associated with more lethal complications compared with coiling without stents.