Clinical and angiographic outcomes of stent-assisted coiling of intracranial aneurysms

Abstract

Background: Despite the increasing use of stent-assisted coiling (SAC), data on its long-term clinical and angiographic results are limited.

Objective: The objective of this article is to assess the long-term clinical and angiographic outcomes in SAC in our single-center practice.

Methods: We conducted a retrospective analysis of intracranial aneurysms treated with detachable coils during the period 2003-2012. Patients were divided into SAC and non-SAC groups and were analyzed for aneurysm occlusion, major recurrence and clinical outcome. Logistic regression analyses identified factors associated with clinical/angiographic outcomes (p value <0.05 was statistically significant).

Results: A total of 516 procedures met inclusion criteria: Sixty-three (12.2%) patients underwent SAC, of whom 56 (89%) had an elective procedure whereas 286 (63.1%) aneurysms from the non-SAC group were ruptured. In the unruptured subcohort, baseline class I was achieved in 24 (38%, p = 0.91), and predischarge modified Rankin scale score (mRS) 0-2 was obtained in 96.4% of cases in the SAC group versus 90.4% in the non-stent group. The major recurrence was 9.5% versus 11.3% in the SAC and non-SAC group, respectively (p = 0.003). At last clinical assessment, 98.2% of the patients from the unruptured SAC group had mRS 0-2 (mean follow-up, 58 months) versus 93.6% (mean follow-up, 56 months) in the unruptured non-SAC group (p = 0.64). Periprocedural vasospasm was associated with long-term poor outcome in the unruptured SAC subcohort (p = 0.0008).

Conclusions: SAC and non-SCA techniques show comparable safety and clinical outcome. The SAC technique significantly decreases retreatment rates. Periprocedural vasospasm resulting from vessel manipulation is associated with poor outcome in SAC of unruptured aneurysms.

Keywords: Intracranial aneurysm; aneurysm; clinical outcome; endovascular treatment; outcome; recanalization; recurrence; stent-assisted coiling; vasospasm.

Figure 1.

Flowchart of procedures, patients and aneurysms. SAC: stent-assisted coiling.

Figure 2.

Rupture status in the entire cohort. SAC: stent-assisted coiling.

Figure 3.

Aneurysm location. SAC: stent-assisted coiling.

Figure 4.

Distribution of the time interval elapsed between the treatment (SAC and non-SAC) and the last angiographic follow-up, for each procedure. SAC: stent-assisted coiling.

Figure 5.

Predischarge/baseline angiographic classification of aneurysm occlusion. SAC: stent-assisted coiling.

Figure 6.

The cumulative hazard of recurrence, retreatment or rerupture^a between non-SAC (red) versus the SAC group (blue) is 2.19 with 95% CI = 1.24–3.85, log-rank test p = 0.0052, censored up to 108 months (nine years). ^aThere was no rupture demonstrated among the unruptured cohort. SAC: stent-assisted coiling; CI: confidence interval.

Figure 7.

Periprocedural complications in SAC and non-SAC subcohorts according to the rupture status. SAC: stent-assisted coiling;

Figure 8.

Unruptured aneurysms within SAC and non-SAC subcohorts: stacked plots of mRS at discharge and at last clinic encounter (corresponding mean follow-up in months in the brackets). SAC: stent-assisted coiling; mRS: modified Rankin scale score.