Long-term angiographic outcome of stent-assisted coiling compared to non-assisted coiling of intracranial saccular aneurysms

Abstract

AimTo compare angiographic result at long-term follow-up, and rates of progressive occlusion, recurrence, and retreatment of stent-assisted coiled (SAC) and non-assisted coiled (NAC) intracranial saccular aneurysms.MethodsRetrospective evaluation of department records identified 260 patients with 283 saccular intracranial aneurysms who had long-term angiographic follow-up (more than 12 months) and were successfully treated with SAC (89 aneurysms) or NAC (194 aneurysms) at the University Hospital Center Zagreb from June 2005 to July 2012. Initial and control angiographic results in both groups were graded using Roy/Raymond scale, converted to descriptive terms, and the differences between them were evaluated for statistical significance. A multivariate analysis was performed to identify factors related to progression of aneurysm occlusion and recurrence at follow-up, and those related to aneurysm retreatment.ResultsThere were more progressively occluded aneurysms in SAC group (38 of 89 aneurysms, 42.7%) than in NAC group (46 of 194, 23.7%) (P = 0.002), but there were no significant differences in the rates of recanalization, regrowth, and stable result. Multivariate logistic regression identified the use of stent as the most important factor associated with progressive occlusion (P = 0.015, odds ratio 2.22, 95% confidence interval 1.17-4.21), and large aneurysm size and posterior circulation location as most predictive of aneurysm recurrence and retreatment.ConclusionThe use of stent is associated with delayed occlusion of initially incompletely coiled aneurysms during follow-up, but does not reduce the rate of recurrence and retreatment compared to coiling alone. Long-term angiographic follow-up is needed for both SAC and NAC aneurysms.

Effect of stenting on progressive occlusion of small unruptured saccular intracranial aneurysms with residual sac immediately after coil embolization: a propensity score analysis

“…More specifically, in the stent group, complete occlusion, neck remnant, and residual sac were noted in 46.3% (100/216), 19.0% (41/216), and 34.7% (75/216), respectively, compared with 63.5% (704/1109), 18.2% (202/1109), and 18.3% (203/1109) in the non-stent group. Ozretic et al 20 showed that only 36.0% (102/283) of aneurysms had complete occlusion. In particular, patients who underwent stent assisted coil embolization showed complete occlusion in 20%, residual neck in 15%, and residual sac in 65%.…”

Jailed double-microcatheter technique following horizontal stenting for coil embolization of intracranial wide-necked bifurcation aneurysms: A technical report of two cases

“…17 Ozretic´et al also reported that SAC did not reduce the rate of recurrence and retreatment. 19 Tight coil packing is, therefore, desirable, even when stents are adjunctively placed.…”

Stent-Assisted Coiling in the Treatment of Unruptured Intracranial Aneurysms: A Randomized Clinical Trial

“…Some studies have reported that aneurysms treated with SAC were less prone to recurrence, 3,5,8,[10][11][12] while other studies did not show such an effect. 4,6,7,9 Higher treatment-related risks of mortality and morbidity were shown in some reports, 3,7,11 but not in others. [4][5][6]8,10 Many studies reported significant baseline differences between the groups being compared, most often with characteristics that could favor SAC (ie, a high proportion of unruptured sidewall aneurysms and shorter follow-up time).…”

“…3,[6][7][8][10][11][12][37][38][39][40] This hypothesis has never been tested in a randomized trial. Previous studies, [3][4][5][6][7][8][9][10] including systematic reviews and meta-analyses, 11,12 have shown diverging results. Some studies have reported that aneurysms treated with SAC were less prone to recurrence, 3,5,8,[10][11][12] while other studies did not show such an effect.…”

“…18 Whether SAC increases procedural risks or improves long-term angiographic results has not been convincingly shown despite multiple case series and metaanalyses published during 20 years. [3][4][5][6][7][8][9][10][11][12] A randomized trial comparing the results of coiling with or without stent placement has never been published.…”