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  • Stent-Assisted Coiling of Cerebrovascular Aneurysms: Experience at a Large Tertiary Care Center

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    Joseph Raynor Linzey BS; Julius Griauzde; Zhe Guan BS; Jessica N. Bentley MD; Joseph J Gemmete MD; Neeraj Chaudhary MBBS; Byron Gregory Thompson MD; Aditya S. Pandey MD

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    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Stent-assisted coiling is a common endovascular technique to treat wide-necked and fusiform cerebral aneurysms. In this study, we evaluated our institutional experience with stent-assisted coiling of cerebral aneurysms to elucidate potential risk factors of recurrence.

    Methods: A retrospective analysis of patients undergoing stent-assisted coiling of cerebral aneurysms from 2005-2012 at the University of Michigan was performed. There were 122 patients with 122 total aneurysms. Demographic data, medical comorbidities, peri-procedural data, and follow up data were collected. The primary outcomes of interest were procedural safety, efficacy, and aneurysm recurrence. Multivariable logistic regression and chi-squared tests were utilized to determine statistical significance of risk factors.

    Results: All 122 stent-assisted coiling procedures led to complete obliteration of the aneurysm with a 2.5% complication rate at the time of treatment. 21 (17.2%) treated patients experienced recurrence at an average follow-up of 297 days. 15 (71.4%) of these were determined to be clinically significant, requiring retreatment. 11 of the 30 (36.7%) procedures that utilized Enterprise stents had a recurrence compared to 10 of the 92 (10.8%) that used Neuroform stents (p=0.001). The average coiling packing density was 20.3% with Enterprise stents and 22.5% with Neuroform stents (p=.8). In multivariable logistic regression, Enterprise stents (odds ratio [OR] 5.81, 95% confidence interval [CI] 1.73-19.57, p=.004) and female sex (0.25 OR, 0.07-0.90, p=.03) were significantly associated with recurrence. Recurrences that required re-coiling were significantly associated with Enterprise stents (8.57 OR, 1.97-37.19, p=.004), female sex (0.19 OR, 0.04-1.00, p=.05), and post-operative dextran use (8.42 OR, 1.40-50.58, p=.02). The other factors did not demonstrate a statistically significant association with recurrence following stent-assisted coiling.

    Conclusions: Stent-assisted coiling for wide-necked and fusiform cerebral aneurysms has a high therapeutic success rate with low procedure related morbidity and mortality. Recurrences occurred more frequently with Enterprise stents than with the Neuroform stents.

    Patient Care: This research will improve patient care by increasing our understanding of the risk factors associated with stent-assisted coiling. As we continue to explore the potential risk factors of this procedure, stent-assisted coiling will continue to become a safer and more cost-effective method of treating cerebral aneurysms.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand that recurrences following stent-assisted coiling are fairly common and 2) Describe key risk factors associated with stent-assisted coiling of cerebral aneurysms


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