Introduction Endovascular management of intracranial aneurysms include stent assisted techniques for wide neck complex aneurysm. Two approaches are being used for stent assisted coiling, single versus staged coiling after stent ‘endothelialization’. Comparative outcomes of these two methods are the purpose of this study.
Methods Medical records and angiographic results were reviewed for 133 aneurysms treated between October 2003 and November 2008 with stent assisted coiling, single stage (62 aneurysms) or staged treatments (71 aneurysms). Demographics, outcomes and angiographic features were reviewed.
Results Patient demographics between the two cohorts were not statistically different by univariate analysis in terms of age, clinical presentation, aneurysm location, follow-up duration and presence of fusiform aneurysms. Aneurysm characteristics in single versus staged treatment were: average neck diameter (5.2±1.6 mm) versus (6.0±2.9 mm) (p=0.07); dome diameter (7.5±3.4 mm) versus (8.9±0.2 mm) (p=0.42); and dome/neck ratio (1.5±0.4) versus (1.4±0.6) (p=0.39) respectively. Fusiform aneurysms were comparable in the two groups. There was a statistically significant difference in immediate, good angiographic results (95–100% occlusion) (55.6% vs 44.5%; p=0.04) but not in long term angiographic results (46.2% vs 53.8%), the need for treatment (11.3% vs 12.6%) or in the rate of in-stent stenosis (7.6% vs 7.6%) in single versus staged treatment. There was no difference in complication rates with regard to coil protrusion (p=0.3), clot/emboli formation (p=0.3) or rupture/dissection (p=0.5). Two patients had rebleeding from a ruptured aneurysm postpartial treatment with single staged stent assisted coiling 3 days after the treatment.
Conclusions In a controlled cohort, aneurysms treated with single stage had a similar long term angiographic results with the same complication rates compared with multistage treatment.
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Competing interests AA—Ev3, Cordis Codman; VA—Micrus, eV3, Cordis Codman.
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