Stability of Cerebral Aneurysms After Stent-Assisted Coil Embolization: A Propensity Score-Matched Analysis. Issue 2 (August 2015)

• Record Type: Journal Article
• Authors: Cho, Won-Sang; Hong, Hyun Sook; Kang, Hyun-Seung; Kim, Jeong Eun; Cho, Young Dae; Kwon, O-Ki; Bang, Jae Seung; Hwang, Gyojun; Son, Young Je; Oh, Chang Wan; Han, Moon Hee
• Is Part Of: Neurosurgery. Volume 77:Issue 2(2015)
• Publication Date: 2015-08
• Subjects: Cerebral aneurysms -- Embolization -- Recanalization -- Risk factor -- Stent; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000000759
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : BACKGROUND: The availability of stents has widened the indications of endovascular intervention for cerebral aneurysms. OBJECTIVE: To elucidate the effect of stents on radiologic outcomes and to analyze the risk factors for aneurysmal recanalization via propensity score matching. METHODS: From the 735 aneurysms treated with coil embolization with stents (n = 187) and without stents (n = 548) between 2009 and 2011, 157 propensity score-matched case pairs were selected. The recanalization rates and relevant risk factors were analyzed. The mean follow-up interval was 24.1 ± 11.3 months (range, 6-48 months) and 22.9 ± 11.4 months (range, 6-56 months) in the stent and nonstent groups, respectively ( P = .388). RESULTS: The stent group demonstrated lower recanalization rates than the nonstent group during both the 6-month (1.9% vs 10.2%, P = .004) and the final follow-up periods (8.3% vs 18.5%, P = .005). The multivariate analysis identified the following significant factors for recanalization: the use of stents (hazard ratio, 0.40; 95% confidence interval, 0.21-0.76, P = .005), larger aneurysm size (hazard ratio, 1.21; 95% confidence interval, 1.11-1.31, P < .001), and initially incomplete occlusion (hazard ratio, 2.39; 95% confidence interval, 1.28-4.43, P = .006). The incidence of permanent neurological complication tended to be higher in the stent group than in the nonstent group (3.2% vs 0%, P = .063). CONCLUSION: In this propensity score-matched analysis, stent implantation reduced the overall recanalization of the coiled cerebral aneurysms. However, the use of stents should be carefully decided upon. ABBREVIATIONS: DSA, digital subtraction angiography mRS, modified Rankin Scale