Peri-Procedural Morbidity and Mortality Associated with Stent-Assisted Coiling for Intracranial Aneurysms

Abstract

<jats:p> Despite experience and technological improvements, stent-assisted coiling for intracranial aneurysms still has inherent risks. We evaluated peri-procedural morbidity and mortality associated with stent-assisted coiling for intracranial aneurysms. </jats:p><jats:p> Patients with cerebral aneurysms that were broad-based (&gt;4 mm) or had unfavorable dome/neck ratios (&lt;1.5) were enrolled in this study between February and November 2011 at our center. Aneurysms were treated with the self-expanding neurovascular stents with adjunctive coil embolization. </jats:p><jats:p> Seventy-two consecutive patients (27 men and 45 women; 22–78 years of age; mean age, 52.8 years) underwent 13 procedures for 13 ruptured aneurysms and 64 procedures for 73 unruptured aneurysms. Nine [11.7%, 95% CI(4.5%–18.9%)] procedure-related complications occurred: one and eight with initial embolization of ruptured and unruptured aneurysms, respectively. Complications included six acute in-stent thromboses, one spontaneous stent migration, one post-procedural aneurysm rupture, and one perforator occlusion. Three complications had no neurologic consequences. Two caused transient neurologic morbidity, two persistent neurologic morbidity, and two death. Procedure-related neurologic morbidity and mortality rates, respectively, were as follows: overall, 5.2% (95%CI, 0.2%–10.2%) and 2.6% (95%CI, 0%–6.2%); ruptured aneurysms, 7.7% (95%CI, 0%–36%) and 0% (95%CI, 0%–25%); unruptured aneurysms, 4.7% (95%CI, 0%–9.9%) and 3.1% (95%CI, 0%–7.3%). Combined procedure-related morbidity and mortality rates for ruptured and unruptured aneurysms were 7.7% (95%CI, 1.7%–13.7%) and 7.8% (95%CI, 1.8%–13.8%), respectively. </jats:p><jats:p> Stent-assisted coiling is an attractive option for intracranial aneurysms. However, stent-assisted coiling for unruptured aneurysms is controversial for its comparable risk to natural history. </jats:p>

Surpass Flow Diverter in the Treatment of Intracranial Aneurysms: A Prospective Multicenter Study

“…If we restricted the analysis to unruptured or nonacutely ruptured aneurysms, the rates of morbidity and mortality varied between 3.8%-8.3% and 0%-3.9%, respectively. [28][29][30][31][32][33][34] The data presented in our study show a safety profile comparable with that of stentassisted coil embolization.…”

Complication analysis in nitinol stent-assisted embolization of 486 intracranial aneurysms

“…Although the long-term durability of SAE has been suggested previously, 6,11,16 there have been fewer reports on the complications associated with this intervention. 4,13,28,34 In the present study, the overall complication rate was 11.7%, whereas the major, permanent morbidity/mortality rate was 3.3%. In a recent publication regarding long-term follow-up for a similarly sized series of patients who underwent SAE, Jahshan et al 16 found a permanent event-related morbidity rate of 4.3% in 489 cases.…”

A new definition for wide-necked cerebral aneurysms

“…the use of an adjunctive device, (2) thromboembolic complication due to insufficient premedication, and (3) patient burden of prolonged general anesthesia. 1)10)11) 15) In summary, in cases with a K-ratio <1.3, we found that adjunctive devices were used heavily when treating unruptured aneurysms with sufficient premedication.…”