Comparison of Stent-Assisted Coiling vs Coiling Alone in 563 Intracranial Aneurysms: Safety and Efficacy at a High-Volume Center.

Abstract

BACKGROUND:

Stent-assisted coiling has been used in both unruptured and ruptured aneurysms, but the safety and efficacy still remain controversial.

OBJECTIVE:

To compare the safety and efficacy of stent-assisted coiling with coiling alone for intracranial aneurysms.

METHODS:

We retrospectively reviewed 512 patients treated by endovascular coiling or stent-assisted coiling over a 1-year period. The patients' clinical and imaging information was recorded. Procedure-related complication rates, recurrence rates, and clinical outcomes were analyzed in both the total aneurysms and the subgroups of ruptured and unruptured aneurysms.

RESULTS:

A total of 243 patients were treated by coiling alone and 269 patients were treated by stent-assisted coiling. Procedure-related complications occurred in 6.2% of patients in the coiling-alone group compared with 6.3% in the stent-assisted coiling group. The procedural permanent morbidity and mortality rates were 1.6% (4/243) and 1.2% (3/243), respectively, in the coiling-alone group and 1.1% (3/269) and 1.5% (4/269), respectively, in the stent-assisted coiling group. A significantly lower recurrence rate was found in the stent-assisted coiling group compared with the coiling-alone group (5.2% vs 16.5%, P = .002). In a comparison of subgroups of ruptured and unruptured aneurysms, the procedural complications rates were comparable in the 2 groups, with a lower recurrence rate in the stent-assisted coiling group. Multivariate analysis showed that larger aneurysm size and higher Hunt and Hess grade were predictors of procedural morbidity; larger aneurysm size, ruptured aneurysm, anterior circulation aneurysms, initial incomplete occlusion, and lack of stent assistance were predictors of recurrence.

CONCLUSION:

Compared with coiling alone, stent-assisted coiling may achieve lower recurrence rates, with comparable procedure-related complications and clinical outcomes in both ruptured and unruptured aneurysms.

• Authors: Hongchao Yang, Yong Sun, Yuhua Jiang, Xianli Lv, Yang Zhao, Youxiang Li, Aihua Liu
• Journal: Neurosurgery (Neurosurgery) Vol. 77 Issue 2 Pg. 241-7; discussion 247 (Aug 2015) ISSN: 1524-4040 [Electronic] United States
• PMID: 25856112 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Academic Medical Centers
• Adult
• Aged
• Aneurysm, Ruptured (surgery)
• Cerebral Angiography
• Endovascular Procedures (adverse effects, methods, mortality)
• Female
• Follow-Up Studies
• Humans
• Intracranial Aneurysm (mortality, pathology, surgery)
• Intraoperative Complications (epidemiology)
• Male
• Middle Aged
• Multivariate Analysis
• Postoperative Complications (epidemiology)
• Predictive Value of Tests
• Recurrence
• Retrospective Studies
• Safety
• Stents (adverse effects)
• Treatment Outcome