Introduction: Endovascular techniques are considered an effective treatment for unruptured intracranial aneurysms. Although wide-necked aneurysms are complex lesions that remain challenging to treat, stent-assisted coiling (SAC) is an acceptable alternative that provide mechanical support to prevent coil prolapse into the lumen as well as a scaffold for endothelization, facilitating aneurysm thrombosis. The aim of this study was to assess procedure-related complications of SAC in the treatment of wide-necked unruptured aneurysms as well as the rate of long-term occlusion results, stent-stenosis, recanalization, and retreatment.
Methods: We retrospectively reviewed our database to include patients with wide-necked unruptured aneurysms who were electively treated with SAC. Medical charts, procedure reports, angiographic, and radiological imaging were analyzed.
Results: We included 120 patients with 124 treated wide-necked unruptured aneurysms from 2004 to 2014. Of the 124 aneurysms, 92 (74.2%) were located in the anterior circulation. The initial complete aneurysm occlusion was achieved in 29% (36/124). The overall procedure-related complication rate was 3.2 % (4/124). Intracranial hemorrhage occurred in three patients due to rupture of the aneurysm and there was one thromboembolic event. The median follow-up time was 21 months (IQR= 10.3 - 40.9). Based on latest imaging follow-up the rate of complete occlusion was 73.5% (75/102). The rate of mild and severe in-stent stenosis was 2.9% (3/102) and 1% (1/102), respectively. The rate of recanalization was 6.6% (5/75). The overall rate of retreatment was 7.8% (8/102) with a median of 10.2 months (IQR= 2.3 - 20.6) after the first procedure was performed. All cause-mortality was 3%.
Conclusions: Stent-assisted coiling is a safe technique to treat wide-neck aneurysms in the endovascular armamentarium in the setting of elective procedure with low-rate of complications, stent-stenosis, and recanalization.
Patient Care: The current study provides data on procedural events following stent-assisted coiling for intracranial aneurysms and will serve as a reference for operators to determine the rate of complications and clinical outcomes.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the relevance of stent-assisted coiling for the treatment of wide-necked aneurysm, 2) Discuss, in small groups, the prevalence of complications following stent-assisted coiling, and 3) Identify an effective strategies to overcome problems with this technique