Targeted and Staged Treatment for Ruptured Wide-neck Intracranial Aneurysms: Bleb Coiling Strategy as a New Approach

Onay, Mehmet; Altay, Cetin Murat; Binboga, Ali Burak

doi:10.1016/j.acra.2021.05.020

Cited by 3 publications

(2 citation statements)

References 27 publications

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“…We consider that without antiplatelet administration during this period, there is no need to weigh the risk of thrombotic complications against the risk of rebleeding caused by inadequate antiplatelet drugs. Therefore, we set the time interval between initial coiling and scheduled stenting as 4 weeks, which is consistent with the previous studies ( 11 , 12 ). However, there is no consensus on this issue due to the scarcity of data.…”

Section: Discussionmentioning

confidence: 78%

“…Brinjikji et al reported only one early rebleeding (3.22%) without additional morbidity in a cohort of 31 patients treated with complementary flow diverters ( 13 ). Recent literature on staged treatments of RIAs with scheduled implantation of stents or various approaches observed no early rebleeding ( 10 – 12 ). In the current study, our results further confirm this observation.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of staged-stent and stent-assisted coiling technique for ruptured saccular wide-necked intracranial aneurysms: Safety and efficacy based on a propensity score-matched cohort study

Zhang

Wei

et al. 2023

Front. Neurol.

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BackgroundApplication of stent-assisted coiling and FD in acute phase of ruptured wide-necked aneurysms is relatively contraindicated due to the potential risk of ischemic and hemorrhagic complications. Scheduled stenting after initial coiling has emerged as an alternative paradigm for ruptured wide-necked aneurysms. The objective of this study is to evaluate the safety and efficacy of a strategy of staged stent-assisted coiling in acutely ruptured saccular wide-necked intracranial aneurysms compared with conventional early stent-assisted coiling strategy via propensity score matching in a high-volume center.MethodsA retrospective review of patients with acutely ruptured saccular wide-necked intracranial aneurysms who underwent staged stent-assisted coiling or conventional stent-assisted coiling from November 2014 to November 2019 was performed. Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared.ResultsA total of 69 patients with staged stent-assisted coiling and 138 patients with conventional stent-assisted coiling were enrolled after 1:2 propensity score matching. The median interval time between previous coiling and later stenting was 4.0 weeks (range 3.5–7.5 weeks). No rebleeding occurred during the intervals. The rate of immediate complete occlusion was lower with initial coiling before scheduled stenting than with conventional stent-assisted coiling (21.7 vs. 60.9%), whereas comparable results were observed at follow-up (82.5 vs. 72.9%; p = 0.357). The clinical follow-up outcomes, overall procedure-related complications and procedure-related mortality between the two groups demonstrated no significant differences (P = 0.232, P = 0.089, P = 0.537, respectively). Multivariate analysis showed that modified Fisher grades (OR = 2.120, P = 0.041) were independent predictors for overall procedure-related complications and no significant predictors for hemorrhagic and ischemic complications.ConclusionsStaged stent-assisted coiling is a safe and effective treatment strategy for acutely ruptured saccular wide-necked intracranial aneurysms, with comparable complete occlusion rates, recurrence rates at follow-up and overall procedure-related complication rates compared with conventional stent-assisted coiling strategy. Staged stent-assisted coiling could be an alternative treatment option for selected ruptured intracranial aneurysms in the future.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Comparison of staged-stent and stent-assisted coiling technique for ruptured saccular wide-necked intracranial aneurysms: Safety and efficacy based on a propensity score-matched cohort study

Zhang

Wei

et al. 2023

Front. Neurol.

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Coiling Variations for Treatment of Ruptured Intracranial Aneurysms: A Meta-Analytical Comparison of Comaneci-, Stent-, and Balloon-Coiling Assistance Techniques

Lim,

Monteiro,

Jacoby

et al. 2023

World Neurosurgery

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Staged stenting strategy of acutely wide-neck ruptured intracranial aneurysms: A meta-analysis and systematic review

Wei

Zhang²,

Zhang³

et al. 2023

Front. Neurol.

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ObjectiveIn the study, we explored the safety and effectiveness of staged stenting strategy for acutely wide-neck ruptured intracranial aneurysms.MethodsOnline databases, including PubMed, EMBASE, the Cochrane database, and Web of Science, were retrospectively and systematically searched. The main observation indicators were the procedure-related complication rate, complete occlusion rate, and favorable clinical outcome. Meta-analysis was performed using a random or fixed effect model based on heterogeneity.ResultsA total of 5 studies with 143 patients were included. The hemorrhagic complication rate of the initial coiling and staged stenting was 2.8% (4 of 143) and 0, respectively. The ischemic complication rate of the coiling and supplemental stenting was 3.5% (5 of 143) and 2.9% (4 of 139), respectively. There were no deaths due to procedure-related complications in two stages. The aneurysm complete occlusion rate was 25% (95% CI, 0.13–0.03; I2 = 4.4%; P = 0.168) after initial coiling, 54% (95% CI, 0.63–0.64; I2 = 0%; P = 0.872) after staged stenting, and 74% (95% CI, 0.66–0.81; I2 = 56.4%; P = 0.562) at follow-up, respectively. Favorable clinical outcome rate 74% (95% CI, 0.61–0.86; I2 = 50.5%; P = 0.133) after discharge of initial coiling treatment, and 86% (95% CI, 0.80–0.92; I2 = 0; P = 0.410) after discharge from stenting, and 97% (95% CI, 0.93–1.01; I2 = 43.8%; P = 0.130) at follow-up.ConclusionStaged stenting treatment of wide-neck RIA with coiling in the acute phase followed by delayed regular stent or flow-diverter stent had high aneurysm occlusion rate, favorable clinical outcome rate and low procedure-related complication rate. A more dedicated and well-designed controlled study is warranted for further evaluation of staged stenting treatment compared to SCA in wide-neck RIA.

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Targeted and Staged Treatment for Ruptured Wide-neck Intracranial Aneurysms: Bleb Coiling Strategy as a New Approach

Cited by 3 publications

References 27 publications

Comparison of staged-stent and stent-assisted coiling technique for ruptured saccular wide-necked intracranial aneurysms: Safety and efficacy based on a propensity score-matched cohort study

Comparison of staged-stent and stent-assisted coiling technique for ruptured saccular wide-necked intracranial aneurysms: Safety and efficacy based on a propensity score-matched cohort study

Coiling Variations for Treatment of Ruptured Intracranial Aneurysms: A Meta-Analytical Comparison of Comaneci-, Stent-, and Balloon-Coiling Assistance Techniques

Staged stenting strategy of acutely wide-neck ruptured intracranial aneurysms: A meta-analysis and systematic review

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