Comparison of Low-Profiled Visualized Intraluminal Support Stent-Assisted Coiling and Coiling Only for Acutely Ruptured Intracranial Aneurysms: Safety and Efficacy Based on a Propensity Score-Matched Cohort Study

Xue, Gaici; Zuo, Qiao; Tang, Haishuang; Zhang, Xiaoxi; Duan, Guoli; Feng, Zhengzhe; Li, Qiang; Yang, Pengfei; Fang, Yibin; Zhao, Kun; Dai, Dongwei; Xu, Yangsheng; Hong, Bo; Huang, Qinghai; Zhao, Rui; Liu, Jianmin

doi:10.1093/neuros/nyaa110_s012

Cited by 4 publications

(7 citation statements)

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“…20 Roh et al 5 has revealed no significant differences in intraprocedural thromboembolic complications and post-procedural cerebral infarct between SAC with Enterprise stent and coiling alone (5.3% vs 4.7%, P = .898, and 2.6% vs 1.6%, P = .710, respectively). 5 Xue et al 4 have also revealed that procedure related thrombosis events of SAC using LVIS were comparable with those of coiling alone for treating RIA (1.9% vs 1.9%, P > .99 and 1.0% vs 0.5%, P > .99, respectively). A systematic review has found that the thromboembolic complication rate of LVIS assisted coiling is 4.9% (95% confidence interval 1.9%-7.9%).…”

Section: Discussionmentioning

confidence: 87%

“…However, all these complications were asymptomatic, and there was no significant difference in rebleeding between the 2 groups. 5 Xue et al 4 showed no significant differences in hemorrhagic complications between SAC using LVIS group and coiling-alone group. In our study, there were no significant differences in hemorrhagic complications including intraprocedural rupture, rebleeding, or EVD related symptomatic bleeding between the SAC group and the coiling-alone group.…”

Section: Discussionmentioning

confidence: 96%

“…1,2 Even with the development of endovascular techniques, coiling is the main strategy and the use of stent-assisted coiling (SAC) is recently increasing for treatment of RIA. 3-6 SAC represents an effective treatment option for complexed and wide neck intracranial aneurysms with higher complete occlusion rates but lower recurrence rates than coiling only. 7-12 However, SAC for RIA is controversial because thromboembolic complications can be derived from complexity of the procedure and limited application of antiplatelet medications.…”

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confidence: 99%

“…13,14 Recent studies have demonstrated comparable periprocedural complication rates of SAC in comparison with coiling alone for treatment of RIA because of improvement of endovascular devices and management of periprocedural antiplatelets. 4,5,15…”

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confidence: 99%

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Comparison of Neuroform Atlas Stent-Assisted Coiling and Coiling Alone in Ruptured Intracranial Aneurysms: A Propensity Score Matching Analysis

Shin

Kim

et al. 2022

Neurosurgery

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BACKGROUND:Although Neuroform Atlas stent is commonly used in stent-assisted coiling (SAC) to treat ruptured intracranial aneurysms (RIA), its safety and efficacy remain controversial.OBJECTIVE:To assess the safety and efficacy of SAC using Neuroform Atlas for treating RIA compared with coiling alone by performing a propensity score matching analysis.METHODS:RIA treated with coiling alone and SAC between January 2017 and May 2021 were retrospectively reviewed. Demographics, periprocedural complication rates, angiographic outcomes, and clinical outcomes of the SAC using Neuroform Atlas group and the coiling-alone group were analyzed with 1:1 propensity score matching.RESULTS:A total of 375 aneurysms were enrolled, and 274 (63.1%) aneurysms were treated with coiling alone. In total, 101 (26.9%) aneurysms were treated with SAC, and Neuroform Atlas stent was used in 71 aneurysms. In propensity score matching, the SAC using Neuroform Atlas group showed higher incidence of complete occlusion (69.0% vs 56.3%, P = .029), lower rate of recanalization (11.3% vs 25.4%, P = .011), and lesser need for retreatment (7.0% vs 16.9%, P = .016) compared with the coiling-alone group. However, there were no significant differences in periprocedural complications such as intraprocedural thrombosis or postprocedural cerebral infarct between the 2 groups.CONCLUSION:The use of Neuroform Atlas is safe and effective for SAC in RIA with comparable procedure-related complication rates but better angiographic outcome in comparison with coiling alone.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 96%

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confidence: 99%

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confidence: 99%

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Comparison of Neuroform Atlas Stent-Assisted Coiling and Coiling Alone in Ruptured Intracranial Aneurysms: A Propensity Score Matching Analysis

Shin

Kim

et al. 2022

Neurosurgery

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“…Low-profile visualized intraluminal support is a self-expanding, retrievable, braided intracranial stent indicated for the treatment of wide-necked intracranial aneurysms with ∼ 23% metal coverage, and previous studies have demonstrated favorable safety and efficacy profiles (8,17). Tian et al (18) compared the hemodynamic effect of the pipeline flow diverter and LVIS stent in aneurysm models and found that a compacted LVIS stent may provide a flow diversion effect comparable to that of PED.…”

Section: Discussionmentioning

confidence: 99%

LVIS-within-enterprise double-stent technique with coil embolization in the treatment of patients with acutely ruptured intracranial vertebrobasilar artery-dissecting aneurysms

Meng

Chen

et al. 2023

Front. Neurol.

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ObjectiveThis study aimed to evaluate the feasibility of the low-profile visualized intraluminal support (LVIS)-within-enterprise double-stent technique for patients with acutely ruptured intracranial vertebrobasilar artery-dissecting aneurysms (ari-VBDAs).MethodsA total of 30 patients with ari-VBDAs who underwent reconstructive treatment using LVIS-within-enterprise double-stent technique with coil embolization between January 2014 and May 2022 were retrospectively enrolled. Patients' characteristics and clinical and imaging outcomes were reviewed. The functional outcomes were assessed using the modified Rankin scale (mRS).ResultsA total of 34 ari-VBDAs were identified, including seven (20.6%) basilar artery aneurysms and 27 (79.4%) vertebral artery aneurysms. All aneurysms were successfully treated in the acute phase. In total, six (20.0%) patients experienced in-hospital serious adverse events, including two deaths (6.7%). The median clinical follow-up time of the remaining 28 patients was 20.0 (IQR, 7.3–40.8) months. The incidences of dependency or death (mRS score of 3–6) at discharge and at the last follow-up were 16.7% and 14.3%, respectively. Aneurysm rebleeding occurred in one (3.3%) patient periprocedurally. In total, three (10.0%) patients had ischemic events, one of which occurred during the periprocedural period and two occurred during follow-up. A total of two patients (6.7%) underwent ventriculoperitoneal shunt. Imaging follow-up was available for 14 patients at the median of 12.0 (IQR, 7.0–12.3) months, with a complete occlusion rate of 93.3% (14/15). In total, one patient experienced parent artery occlusion, and no aneurysm was recanalized.ConclusionLVIS-within-enterprise double-stent technique with coil embolization for the treatment of patients with ari-VBDAs could be performed with a good safety profile and high technical success rate. The rate of complete aneurysm occlusion during follow-up seemed to be satisfactory.

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Safety of dual antiplatelet therapy in the acute phase of aneurysmal subarachnoid hemorrhage: a propensity score–matched study

Qoorchi Moheb Seraj,

Mirbolouk,

Vaezi

et al. 2023

Neurosurgical Focus

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OBJECTIVE With the evolution of neuroendovascular treatments, there is a great trend to treat acutely ruptured wide-necked aneurysms with stent-assisted coiling (SAC) and flow diverters (FDs), which inevitably requires dual antiplatelet therapy (DAPT). This therapy can increase the rate of hemorrhagic complications following other neurosurgical maneuvers, such as external ventricular drain (EVD) placement or removal. In this study, the authors aimed to evaluate the safety of DAPT in patients with aneurysmal subarachnoid hemorrhage (SAH) treated with SAC or FDs and the therapy’s potential benefit in reducing cerebral ischemia and cerebral vasospasm. METHODS In this retrospective study, the authors reviewed the records of patients who had been admitted to their hospital with acute aneurysmal SAH and treated with SAC, FDs, and/or coiling between 2012 and 2022. Patients were classified into two groups: a DAPT group, including patients who had received DAPT for SAC or FDs, and a non-DAPT group, including patients who had not received any antiplatelet regimen and had been treated with coiling. Perioperative hemorrhagic and ischemic complications and clinical outcomes were compared between the two groups. RESULTS From among 938 cases of acute ruptured aneurysms treated during 10 years of study, 192 patients were included in this analysis, with 96 patients in each treatment group, after propensity score matching. All basic clinical and imaging characteristics were equivalent between the two groups except for the neck size of aneurysms (p < 0.001). EVD-related hemorrhage was significantly higher in the DAPT group than in the non-DAPT group (p = 0.035). In most patients, however, the EVD-related hemorrhage was insignificant. Parent artery or stent-induced thrombosis was higher in the DAPT group than in the non-DAPT group (p = 0.003). The rate of cerebral ischemia was slightly lower in the DAPT group than in the non-DAPT group (11.5% vs 15.6%, p = 0.399). In the multivariate analysis, cerebral ischemia, rebleeding before securing the aneurysm, extracranial hemorrhage, and cerebral vasospasm were the predictive factors of a poor clinical outcome (p < 0.001, p < 0.001, p = 0.038, and p = 0.038, respectively). CONCLUSIONS The DAPT regimen may be safe in the setting of acute aneurysmal SAH. Although EVD-related hemorrhage is more common in the DAPT group than the non-DAPT group, it is usually insignificant without any neurological deficit.

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Comparison of Low-Profiled Visualized Intraluminal Support Stent-Assisted Coiling and Coiling Only for Acutely Ruptured Intracranial Aneurysms: Safety and Efficacy Based on a Propensity Score-Matched Cohort Study

Cited by 4 publications

References 0 publications

Comparison of Neuroform Atlas Stent-Assisted Coiling and Coiling Alone in Ruptured Intracranial Aneurysms: A Propensity Score Matching Analysis

Comparison of Neuroform Atlas Stent-Assisted Coiling and Coiling Alone in Ruptured Intracranial Aneurysms: A Propensity Score Matching Analysis

LVIS-within-enterprise double-stent technique with coil embolization in the treatment of patients with acutely ruptured intracranial vertebrobasilar artery-dissecting aneurysms

Safety of dual antiplatelet therapy in the acute phase of aneurysmal subarachnoid hemorrhage: a propensity score–matched study

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