Comparison of stent-assisted and no-stent coil embolization for safety and effectiveness in the treatment of ruptured intracranial aneurysms

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  • 1 Department of Neurosurgery,
  • 2 Focused Training Center for Trauma, and
  • 3 Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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OBJECTIVE

The safety of the stent-assisted coil embolization (SAC) technique for acutely ruptured aneurysms has not been established yet. SAC is believed to be associated with a high risk of thromboembolic and hemorrhagic complications in acute subarachnoid hemorrhage (SAH). The aim of this study was to evaluate the safety and efficacy of the SAC technique in the setting of acutely ruptured aneurysm.

METHODS

A total of 102 patients who received endovascular treatment for acute SAH between January 2011 and December 2017 were enrolled. The SAC technique was performed in 38 of these patients, whereas the no-stent coil embolization (NSC) technique was performed in 64. The safety and efficacy of the SAC technique in acute SAH was evaluated as compared with the NSC technique by retrospective analysis of radiological and clinical outcomes.

RESULTS

There were no significant differences in clinical or angiographic outcomes between the SAC and NSC techniques in patients with acute SAH. The rate of ventriculostomy-related hemorrhagic complications was higher in the SAC group than that in the NSC group (63.6% vs 12.5%; OR 12.25, 95% CI 1.78–83.94, p = 0.01). However, all these complications were asymptomatic and so small that they were only able to be diagnosed with imaging.

CONCLUSIONS

Ruptured wide-necked aneurysms could be effectively and safely treated with the SAC technique, which showed clinical and angiographic outcomes similar to those of the NSC technique. Hence, the SAC technique with dual-antiplatelet drugs may be a viable option even in acute SAH.

ABBREVIATIONS CTA = CT angiography; EVD = external ventricular drainage; ICP = intracranial pressure; MRA = MR angiography; mRS = modified Rankin Scale; NSC = no-stent coil embolization; SAC = stent-assisted coil embolization; SAH = subarachnoid hemorrhage.

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Contributor Notes

Correspondence Wonki Yoon: Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea. nvkumc@gmail.com.

INCLUDE WHEN CITING Published online August 30, 2019; DOI: 10.3171/2019.5.JNS19988.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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