Comparison of Stent-Assisted Coiling vs Coiling Alone in 563 Intracranial Aneurysms: Safety and Efficacy at a High-Volume Center. Issue 2 (August 2015)

• Record Type: Journal Article
• Authors: Yang, Hongchao; Sun, Yong; Jiang, Yuhua; Lv, Xianli; Zhao, Yang; Li, Youxiang; Liu, Aihua
• Is Part Of: Neurosurgery. Volume 77:Issue 2(2015)
• Publication Date: 2015-08
• Subjects: Cerebral aneurysm -- Coil -- Endovascular -- Stent; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000000765
• Languages: English
• ISSNs: 0148-396X

Abstract

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. ABBREVIATIONS: HH, Hunt and Hess mRS, modified Rankin Scale