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

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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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Flowchart of 102 patients who were treated with SAC or NSC in the setting of acute SAH between January 2011 and December 2017.

  • View in gallery

    Graph showing mRS scores at the last clinical follow-up. Clinical follow-up was available for 53 patients (82.8%) in the NSC group (mean 881.25 days; range 102–2517 days) and 30 patients (78.9%) in the SAC group (mean 810.67 days; range 133–2157 days). Figure is available in color online only.

  • View in gallery

    Asymptomatic EVD track hemorrhage demonstrated on plain radiographic image (A) and CT images (B–D).

References

  • 1

    Amenta PSDalyai RTKung DToporowski AChandela SHasan D: Stent-assisted coiling of wide-necked aneurysms in the setting of acute subarachnoid hemorrhage: experience in 65 patients. Neurosurgery 70:141514292012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Bechan RSSprengers MEMajoie CBPeluso JPSluzewski Mvan Rooij WJ: Stent-assisted coil embolization of intracranial aneurysms: complications in acutely ruptured versus unruptured aneurysms. AJNR Am J Neuroradiol 37:5025072016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Biondi AJanardhan VKatz JMSalvaggio KRiina HAGobin YP: Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery 61:4604692007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Bodily KDCloft HJLanzino GFiorella DJWhite PMKallmes DF: Stent-assisted coiling in acutely ruptured intracranial aneurysms: a qualitative, systematic review of the literature. AJNR Am J Neuroradiol 32:123212362011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Bulters DOSantarius TChia HLParker RATrivedi RKirkpatrick PJ: Causes of neurological deficits following clipping of 200 consecutive ruptured aneurysms in patients with good-grade aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 153:2953032011

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Chalouhi NJabbour PSinghal SDrueding RStarke RMDalyai RT: Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke 44:134813532013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Chung JLim YCSuh SHShim YSKim YBJoo JY: Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period: incidence of and risk factors for periprocedural complications. J Neurosurg 121:4112014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Colby GPPaul ARRadvany MGGandhi DGailloud PHuang J: A single center comparison of coiling versus stent assisted coiling in 90 consecutive paraophthalmic region aneurysms. J Neurointerv Surg 4:1161202012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    dos Santos Souza MPAgid RWillinsky RACusimano MMontanera WWallace MC: Microstent-assisted coiling for wide-necked intracranial aneurysms. Can J Neurol Sci 32:71812005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Ergina PLCook JABlazeby JMBoutron IClavien PAReeves BC: Challenges in evaluating surgical innovation. Lancet 374:109711042009

  • 11

    Fargen KMHoh BLWelch BGPride GLLanzino GBoulos AS: Long-term results of enterprise stent-assisted coiling of cerebral aneurysms. Neurosurgery 71:2392442012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Guglielmi GViñuela FSepetka IMacellari V: Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg 75:171991

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Higashida RTSmith WGress DUrwin RDowd CFBalousek PA: Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. J Neurosurg 87:9449491997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Katsaridis VPapagiannaki CViolaris C: Embolization of acutely ruptured and unruptured wide-necked cerebral aneurysms using the neuroform2 stent without pretreatment with antiplatelets: a single center experience. AJNR Am J Neuroradiol 27:112311282006

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Kung DKPoliceni BACapuano AWRossen JDJabbour PMTorner JC: Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling. J Neurosurg 114:102110272011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Mocco JSnyder KVAlbuquerque FCBendok BRAlan S BCarpenter JS: Treatment of intracranial aneurysms with the Enterprise stent: a multicenter registry. J Neurosurg 110:35392009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Molyneux AKerr RStratton ISandercock PClarke MShrimpton J: International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:126712742002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Molyneux AJKerr RSYu LMClarke MSneade MYarnold JA: International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:8098172005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Nishido HPiotin MBartolini BPistocchi SRedjem HBlanc R: Analysis of complications and recurrences of aneurysm coiling with special emphasis on the stent-assisted technique. AJNR Am J Neuroradiol 35:3393442014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Piotin MBlanc RSpelle LMounayer CPiantino RSchmidt PJ: Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke 41:1101152010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Raymond JGuilbert FWeill AGeorganos SAJuravsky LLambert A: Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:139814032003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Serebruany VLSteinhubl SRBerger PBMalinin AIBaggish JSBhatt DL: Analysis of risk of bleeding complications after different doses of aspirin in 192,036 patients enrolled in 31 randomized controlled trials. Am J Cardiol 95:121812222005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Tähtinen OIVanninen RLManninen HIRautio RHaapanen ANiskakangas T: Wide-necked intracranial aneurysms: treatment with stent-assisted coil embolization during acute (<72 hours) subarachnoid hemorrhage—experience in 61 consecutive patients. Radiology 253:1992082009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Yamada NKCross DT IIIPilgram TKMoran CJDerdeyn CPDacey RG Jr: Effect of antiplatelet therapy on thromboembolic complications of elective coil embolization of cerebral aneurysms. AJNR Am J Neuroradiol 28:177817822007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Yang HSun YJiang YLv XZhao YLi Y: Comparison of stent-assisted coiling vs coiling alone in 563 intracranial aneurysms: safety and efficacy at a high-volume center. Neurosurgery 77:2412472015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Yang PZhao KZhou YZhao RZhang LZhao W: Stent-assisted coil placement for the treatment of 211 acutely ruptured wide-necked intracranial aneurysms: a single-center 11-year experience. Radiology 276:6192015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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