Safety and effectiveness of stent-assisted coiling with adjunctive techniques in ruptured acute aneurysms: a propensity score–matched cohort study

Abstract

OBJECTIVE The use of stent-assisted coiling (SAC) in acute subarachnoid hemorrhage cases is associated with higher incidence rates of bleeding and ischemic complications. The aim of this study was to evaluate the safety and efficacy of the SAC technique in the treatment of ruptured intracranial aneurysms (RIAs). METHODS A retrospective analysis was conducted on patients with RIAs treated with SAC or coiling alone (CA). Univariate analysis compared clinical information between the two groups. Propensity score matching was used to select patients for comparison and analyze surgical complications, prognosis, and imaging outcomes in both groups. RESULTS A total of 394 aneurysms were included, and 272 aneurysms remained after application of propensity score matching, with an equal distribution of 136 cases in both the SAC and CA groups. There was no statistically significant difference in the immediate postoperative outcomes between the two groups (63.2% of SAC patients achieved class 1 on the Raymond-Roy occlusion classification scale vs 58.8% of CA patients, difference [95% CI] 4.4% [−0.076 to 0.163]; 33.1% achieved class 2 vs 38.2%, 5.1% [−0.065 to 0.170]; 3.7% achieved class 3 vs 2.9%, 0.8% [−0.047 to 0.062], p = 0.506). At the 1-year follow-up, the SAC group exhibited higher rates of complete occlusion (59.5% vs 42.4%, 17.1% [0.040–0.294]) and stability (24.0% vs 19.2%, 4.8% [−0.061 to 0.156]), while experiencing lower rates of improvement (12.4% vs 22.4%, 10.0% [0.001–0.201]) and recanalization (4.1% vs 16.0%, 11.9% [0.036–0.120]), with statistically significant differences in these outcomes (p < 0.001). No significant disparities were observed in clinical outcomes in terms of modified Rankin Scale (mRS) scores at discharge (76.5% vs 77.2% had mRS score 0–2, 0.7% [−0.098 to 0.113]; 23.5% vs 22.8% had mRS score 3–6, 0.7% [−0.098 to 0.113], p = 0.886) and 1-year follow-up (90.8% vs 92.2% had mRS score 0–2, 1.4% [−0.063 to 0.091]; 9.2% vs 7.8% had mRS score 3–6, 1.4% [−0.063 to 0.091], p = 0.683). Intraoperative rupture occurred more frequently in the SAC group compared with the CA group, although the difference was not statistically significant (5.1% vs 2.9%, 2.2% [−0.035 to 0.081], p = 0.356). The SAC group demonstrated a higher incidence of intraoperative thrombosis, but the difference was not statistically significant (8.1% vs 2.9%, 5.2% [−0.010 to 0.117], p = 0.063). Postoperative thrombosis in the SAC group was 3 times higher, but this difference was not statistically significant (6.6% vs 2.2%, 4.4% [−0.013, 0.106], p = 0.076). The surgery-related mortality rates did not differ significantly between the two groups (4.4% vs 5.9%, 1.5% [−0.048 to 0.077], p = 0.583). CONCLUSIONS Although stent treatment for RIA results in some incidents of complications, it is safe and effective. Besides, the SAC group showed better vascular imaging results compared with the CA group.

Textbook Outcomes Among Patients with Aneurysmal Subarachnoid Hemorrhage Following Endovascular Treatment

“…Recently, a retrospective analysis of patients with acute wide-necked ruptured intracranial aneurysms treated with endovascular therapy revealed that patients treated with SAC achieved a higher rate of complete occlusion, a lower recurrence rate, and a greater incidence of procedure-related complications than did those treated with CA. However, the occurrence of these complications was low and comparable [ 40 ]. These outcomes are consistent with the results of our study.…”