Stent-assisted coiling of cerebral aneurysms: multi-center analysis of radiographic and clinical outcomes in 659 patients

Abstract

IntroductionThe endovascular stent-assisted coiling approach for the treatment of cerebral aneurysms is evolving rapidly with the availability of new stent devices. It remains unknown how each type of stent affects the safety and efficacy of the stent-coiling procedure.MethodsThis study compared the outcomes of endovascular coiling of cerebral aneurysms using Neuroform (NEU), Enterprise (EP), and Low-profile Visualized Intraluminal Support (LVIS) stents. Patient characteristics, treatment details and angiographic results using the Raymond–Roy grade scale (RRGS), and procedural complications were analyzed in our study.ResultsOur study included 659 patients with 670 cerebral aneurysms treated with stent-assisted coiling (NEU, n=182; EP, n=158; LVIS, n=330) that were retrospectively collected from six academic centers. Patient characteristics included mean age 56.3±12.1 years old, female prevalence 73.9%, and aneurysm rupture on initial presentation of 18.8%. We found differences in complete occlusion on baseline imaging, defined as RRGS I, among the three stents: LVIS 64.4%, 210/326; NEU 56.2%, 95/169; EP 47.6%, 68/143; P=0.008. The difference of complete occlusion on 10.5 months (mean) and 8 months (median) angiographic follow-up remained significant: LVIS 84%, 251/299; NEU 78%, 117/150; EP 67%, 83/123; P=0.004. There were 7% (47/670) intra-procedural complications and 11.5% (73/632) post-procedural-related complications in our cohort. Furthermore, procedure-related complications were higher in the braided-stents vs laser-cut, P=0.002.ConclusionsThere was a great variability in techniques and choice of stent type for stent-assisted coiling among the participating centers. The type of stent was associated with immediate and long-term angiographic outcomes. Randomized prospective trials comparing the different types of stents are warranted.

Advances in endovascular aneurysm management: coiling and adjunctive devices

“…A multicentre retrospective study with 659 patients published in 2019 shows a statistically significant difference (p=0.004) in complete occlusion for 84% of patients receiving LVIS stent (251/299) compared with 78% of those receiving Neuroform stent (117/150) and 67% of those Enterprise stent (83/123). The complete occlusion was determined from follow-up angiography, occurring an average of 10.5 months after treatment 30…”

Clinical and Angiographic Outcomes After Stent-Assisted Coiling of Cerebral Aneurysms With Laser-Cut and Braided Stents: A Comparative Analysis of the Literatures

“…Self-expanding braided stents have greater metal surface coverage and provide greater flow diversion to promote aneurysmal occlusion; examples include LVIS (Microvention, Aliso Viejo, CA, USA), LVIS Jr (Microvention), and LEO Baby (Balt, Montmorency, France). Both stent types are widely used in IA management and type superiority has not been established ( 5 , 6 ).…”

Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up

“…Laser-cut stents with closed-cell design can kink in tight arterial bends or ovalize crossing curves on different vessel diameter [ 13 ]. Furthermore, the lack of re-sheathing, which is necessary in cases with high vessel tortuosity, constitutes a significant disadvantage of such stents, which results in increased tension being exerted on the equipment, and can cause dislocation during deployment [ 8 , 19 ]. From the operator’s point of view, the essential features include the stent’s excellent visibility during the procedure, its flexibility and easy adaptation to the curvatures of vascular anatomy, and good adherence to the vessel wall, all of which reduce the risk of clotting and accelerate endothelialization.…”

“…However, stents remain the largest and most commonly used group by neuroradiologists. Stents are used, mostly, for the security of coil protrusion into the parent artery, coil stability in the aneurysm sac, and increasing the packing density [ 2 , 8 , 9 ]. They also possess other qualities, e.g., they cause a partial change in arterial geometry that causes flow vector to change within the aneurysm [ 10 ].…”