Safety and Efficacy of Stent-assisted Coiling in the Treatment of Unruptured Wide-necked Intracranial Aneurysms: A Single-center Experience

Abstract

Introduction: Wide-necked intracranial aneurysms (IAs) are complex lesions that may require different microsurgical or endovascular strategies, and stent-assisted coiling (SAC) has emerged as a feasible alternative to treat this subset of aneurysms. Methods: The objective was to assess the rate of complications of unruptured wide-necked IAs treated with SAC. We retrospectively identified patients with unruptured wide-necked IAs treated with SAC. Medical charts, procedure reports, and imaging studies were analyzed. Results: One hundred twenty patients harboring 124 unruptured wide-necked IAs were included. Ninety-two aneurysms (74.2%) were located in the anterior circulation. The median aneurysm size was 7 mm (IQR = 5-10). The immediate complete aneurysm occlusion rate was 29% (36/124). The rate of procedural complications was 3.3 % (4/120), which included 2 intraprocedural aneurysm ruptures, 1 immediate postprocedure aneurysm rupture, and 1 vessel occlusion rescued with an open-cell stent. The median follow-up time was 21 months (IQR = 10.3-40.9). Kaplan-Meier analysis estimated a median time of complete aneurysm occlusion of 6.3 months (95%CI = 3.8-7.8). At 30-day follow-up, 80.7% of patients had a Glasgow Outcome Score (GOS) of 5 and at the latest follow-up 83.9%. Imaging follow-up was available for 102 patients. The rate of complete aneurysm occlusion was 73.5% (75/102), severe in-stent stenosis (>50%) was found in 1% (1/102), the recanalization rate was 6.6% (5/75), and the retreatment rate was 7.8% (8/102). Conclusion: SAC remains a safe and effective technique to treat wide-necked IAs, providing a low rate of complications and recanalization with excellent long-term aneurysm occlusion rates.

Angiographic Follow-Up for Small Ruptured Intracranial Aneurysm Treated by Endovascular Treatment : Follow-Up Plan and Long-Term Follow-Up Results

“…3). As previously demonstrated in other studies, it was confirmed that the use of stents was associated with lower rates of aneurysm recurrence 1,3,4,9,16,34) . Lawson et al 16) reported that stent-assisted coiling caused the progression of occlusion and the complete thrombosis of incompletely coiled aneurysms, possibly by a flow remodeling effect.…”

Wingspan Stenting for Symptomatic Severe In-Stent Stenosis of a Closed-Cell Stent after Stent-Assisted Coiling of a Ruptured Intracranial Aneurysm

“…Since the first report in 2006, there have been 6 reported cases that were treated for symptomatic in-stent stenosis in stents used for coiling of intracranial aneurysms ( Table 1 ). 4 7 8 9 No report has mentioned long-term follow-up result of in-stent stenosis treatment, except for the present case. Moreover, only in the present case, symptomatic in-stent stenosis by a closed-cell stent, the Enterprise stent, was treated.…”

Short- and midterm outcome of ruptured and unruptured intracerebral wide-necked aneurysms with microsurgical treatment

“…In addition, a direct comparison is hard to perform since the main limitation would be the definition of an adequate occlusion and periprocedural complication. Besides recently, endovascular techniques like T-stenting assisted coiling has been introduced which show a comparable high complete occlusion grade of 73–83% in WNA with a stable result in the follow-up analysis and low complication rate 17 , 18 . Still one should notice that in contrast to microsurgical treatment, the retreatment rate of all alternative endovascular treatment is still higher, which is associated with a higher morbidity and mortality during long-term FU 16 , 19 .…”