Stent-assisted coiling vs. coiling alone of ruptured tiny intracranial aneurysms: A contemporary cohort study in a high-volume center

Abstract

ObjectiveThis study aims to compare the safety and efficacy of stent-assisted coiling (SAC) with those of coiling alone (CA) for the treatment of ruptured tiny intracranial aneurysms.MethodsWe enrolled 245 patients with ruptured tiny intracranial aneurysms treated with coil embolization. Patients were grouped into SAC and CA groups. Baseline characteristics, periprocedural complications, clinical outcomes, and angiographic results were compared between the two groups. In addition, a subgroup analysis was conducted in the SAC group, and patients were regrouped into low-profile visualized intraluminal support (LVIS) and laser-cut groups to compare the perioperative procedure-related complications and clinical and angiographic follow-up outcomes.ResultsAll baseline characteristics were equivalent between the two groups except for aneurysm size and dome-to-neck aspect ratio. The rates of overall procedure-related complications, intraprocedural rupture, postoperative early rebleeding, intraprocedural thrombosis, postprocedural thrombosis, and procedure-related mortality were comparable between the two groups (P = 0.105, 0.145, 0.308, 1.000, 1.000, 0.160, respectively). Nevertheless, the rate of hemorrhagic complication in the SAC group was significantly higher (P = 0.023). The angiographic follow-up outcomes showed that the SAC group had a higher complete occlusion rate and lower recurrence rate (88.2 vs. 67.1%, 5.4 vs. 15.2%, P = 0.001). The clinical outcomes at discharge and follow-up between the two groups demonstrated no significant differences (P = 0.192 and P = 0.085, respectively). For subgroup analysis, LVIS stents were associated with a significantly higher rate of complete occlusion (P = 0.014) and a lower rate of intraprocedural rupture (p = 0.021). Moreover, multivariate analysis showed that there were no predictors for the overall, hemorrhagic, and ischemic procedure-related complications, while Raymond class was an independent predictor of retreatment (OR = 3.508, 95% CI 1.168–11.603; P = 0.029).ConclusionStent-assisted coiling may increase the incidence of hemorrhagic events with favorable angiographic results and comparable clinical outcomes compared with stand-alone coiling. Nevertheless, LVIS stent could improve the safety compared with lazer-cut stent. Simultaneously, considering the better long-term effect, LVIS stent-assisted coiling may be a preferable choice for ruptured tiny intracranial aneurysms.

Coil embolization for ruptured and unruptured very small intracranial aneurysms: A retrospective review of a 10-year single-center experience

“…The wide-necked nature of VSIAs is a potent risk factor for coil protrusion into the parent artery. As in previous studies, [9,18,19] most (78%) of the VSIAs in our series were relatively wide-necked. To overcome this anatomical difficulty, we performed adjuvant techniques using stent-assisted coiling (SAC), catheter protection, and the double catheter technique, which were successful in preventing coil protrusion.…”

“…A careful preoperative plan, adequate antiplatelet medication, and the use of a new generation of low-profile stents are recommended. Recently, several studies reported the use of SAC in acutely ruptured VSIAs [9,18,19] with low complication, high occlusion, and low recurrence rates. However, previous studies have suggested that SAC in acutely ruptured IAs increased the risk of ischemic and hemorrhagic complications due to insufficient platelet inhibition and dual-antiplatelet medication after SAC.…”

“…Although we could not identify the predictive factors that influence recurrence, the literature suggests that SAC is an independent factor affecting the postoperative recurrence of VSIAs. [9,19,20]…”

“…Recent studies reported 7.5% and 17.1% of postoperative recurrence rates in treating ruptured VSIAs using coil embolization. [9,19] Qin et al [9] performed retreatment in 7/18 patients with recurrences, and the retreatment rate was 6.7%. Although we could not identify the predictive factors that influence recurrence, the literature suggests that SAC is an independent factor affecting the postoperative recurrence of VSIAs.…”

Outcome after Neuro-interventional Treatment of Intracranial Aneurysm (as a First Treatment Modality)

“…These limitations resulted in the advent of new endovascular approaches, e.g., balloon-assisted coiling (BAC), stent-assisted coiling (SAC), flow diversion stenting, and flow disruption approach (Pierot and Wakhloo, 2013). These methods have been widely studied in terms of their clinical efficacy and long-term complications ( Juvela, 2003;Zhang et al, 2022).…”