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AJNR Am J Neuroradiol ; 35(2): 339-44, 2014 Feb.
Article in English | MEDLINE | ID: mdl-23907240

ABSTRACT

BACKGROUND AND PURPOSE: Stent-assisted coiling has expanded the treatment of intracranial aneurysms. With the use of continuously compiled data, we reviewed the role and drawbacks of stent-assisted coiling. MATERIALS AND METHODS: We compiled data from consecutive patients from 2003-2012 who underwent coiling, with or without stent assistance. Clinical and angiographic results were analyzed retrospectively. RESULTS: Of 1815 saccular aneurysms in 1505 patients, 323 (17.8%) were treated with stents (299 procedures) and 1492 (82.2%) without stents (1400 procedures). Procedure-related complications occurred in 9.4% with stents versus 5.6% without stents (P = .016, relative risk 1.5; 95% CI, 1.1-2.7). Ischemic complications were more frequent in the stent group than in the no-stent group (7.0% versus 3.5%; P = .005; relative risk, 1.7; 95% CI 1.2-2.5), as were hemorrhagic complications (2.3% versus 1.9%, P = .64). Procedure-induced mortality occurred in 2.7% (8/299) with stents versus 1.1% (15/1400) without stents (P = .029; relative risk, 2.0; 95% CI, 1.1-3.5). Logistic regression analysis identified wide-neck aneurysms as the most significant independent predictor of complications. A total of 64.1% (207/323) of aneurysms treated with stents and 70.3% (1049/1492) treated without stents have been followed, disclosing angiographic recurrence in 15.5% (32/207) versus 35.5% (372/1049), respectively (P < .0001). Logistic regression analysis showed that the presence of a stent was the most important factor for the reduction of angiographic recurrence (P < .0001; relative risk, 2.3; 95% CI, 1.6-3.3). CONCLUSIONS: The stent-assisted coiling technique is associated with a significant decrease in recurrences but a significant increase in complications. The treatment of wide-neck aneurysms remains hazardous.


Subject(s)
Cerebral Hemorrhage/mortality , Intracranial Aneurysm/mortality , Intracranial Aneurysm/surgery , Mechanical Thrombolysis/mortality , Postoperative Complications/mortality , Stents/statistics & numerical data , Stroke/mortality , Cerebral Hemorrhage/diagnostic imaging , Female , France/epidemiology , Humans , Incidence , Intracranial Aneurysm/diagnostic imaging , Longitudinal Studies , Male , Middle Aged , Postoperative Complications/diagnostic imaging , Radiography , Recurrence , Retrospective Studies , Risk Assessment , Stroke/diagnostic imaging , Survival Rate , Treatment Outcome
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