Introduction: Stents have broadened the range of aneurysms amenable to endovascular repair, but the safety and efficacy of different intracranial stents and stents configurations is not well-defined. This study compares the complication rates of aneurysms treated with Neuroform, Enterprise, and Pipeline (PED) stents.
Methods: Over ten years, 521 aneurysms were treated with stent-assisted embolization using Neuroform (337), Enterprise (111), PED (33), Wingspan (1), and multiple stent types (39). A single stent was used for 405 aneurysms, and overlapping stents were employed in 94. Twenty-two aneurysms required other configurations. The aneurysm population consisted of 373 small, 97 large, 13 giant, and 38 fusiform aneurysms. Univariate and multivariate chi-squared analysis evaluated the effect of stent selection, stent configuration, and aneurysms size with respect to neurological events.
Results: In over 720 aneurysm-years of follow up, 65 aneurysms had neurological complications resulting in 27 (5.2%) transient, 19 (3.6%) minor, and 10 (1.9%) major deficits, and 9 (1.7%) mortalities. No significant difference in major complication rates existed between Neuroform, Enterprise, and PED, but there was a trend toward more total complications with PED. Compared to single stent repair (1.2%), both overlapping (10.6%, RR 8.6) and Y-configuration (15%, RR 12.2) stent constructs had significantly more major complications. Compared to small aneurysms (2.1%), large (4.1%, RR 1.9), giant (23.1%, RR 10.8), and fusiform (13.2%, RR 6.1) aneurysms had more major complications. Multivariate analysis did not show significant covariance between stent configuration and aneurysm size or morphology with respect to complications.
Conclusions: The combined major morbidity and mortality rate of 3.6% shows that stent-assisted endovascular repair has been a relatively safe option for this population of complex aneurysms. While single-stent constructs provide excellent results, when considering multiple stents, the increased risk should be weighed against the advantages of improved parent vessel reconstruction.
Patient Care: The present research helps clarify the role of stenting in the treatment of cerebral aneurysms. Successes will be acknowledged, but the emphasis on complications will help other endovascular neurosurgeons improve treatment strategies to avoid complications in the future.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the commonly used intracranial stents and stent configurations including their indications, 2) Understand the risks and benefits of different stent constructs, 3) Describe complication rates and complication avoidment strategies in stenting for cerebral aneurysms.