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Hemorrhagic Stroke
Original research
Stent-assisted coiling of cerebral aneurysms: multi-center analysis of radiographic and clinical outcomes in 659 patients
  1. Maxim Mokin1,
  2. Christopher T Primiani1,
  3. Zeguang Ren1,
  4. Keaton Piper1,
  5. David J Fiorella2,
  6. Ansaar T Rai3,
  7. Kirill Orlov4,
  8. Dmitry Kislitsin4,
  9. Anton Gorbatykh4,
  10. J Mocco5,
  11. Reade De Leacy5,
  12. Joyce Lee5,
  13. Jan Vargas Machaj6,
  14. Raymond Turner6,
  15. Imran Chaudry6,
  16. Aquilla S Turk6
  1. 1 Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
  2. 2 Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
  3. 3 Department of Neurointerventional Radiology, West Virginia University, Morgantown, West Virginia, USA
  4. 4 Meshalkin Novosibirsk Research Institute of Circulation Pathology (NRICP), Novosibirsk, Russian Federation
  5. 5 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  6. 6 Department of Surgery, Prisma Health, Greenville, South Carolina, USA
  1. Correspondence to Dr. Maxim Mokin; mokin{at}health.usf.edu

Abstract

Introduction The endovascular stent-assisted coiling approach for the treatment of cerebral aneurysms is evolving rapidly with the availability of new stent devices. It remains unknown how each type of stent affects the safety and efficacy of the stent-coiling procedure.

Methods This study compared the outcomes of endovascular coiling of cerebral aneurysms using Neuroform (NEU), Enterprise (EP), and Low-profile Visualized Intraluminal Support (LVIS) stents. Patient characteristics, treatment details and angiographic results using the Raymond–Roy grade scale (RRGS), and procedural complications were analyzed in our study.

Results Our study included 659 patients with 670 cerebral aneurysms treated with stent-assisted coiling (NEU, n=182; EP, n=158; LVIS, n=330) that were retrospectively collected from six academic centers. Patient characteristics included mean age 56.3±12.1 years old, female prevalence 73.9%, and aneurysm rupture on initial presentation of 18.8%. We found differences in complete occlusion on baseline imaging, defined as RRGS I, among the three stents: LVIS 64.4%, 210/326; NEU 56.2%, 95/169; EP 47.6%, 68/143; P=0.008. The difference of complete occlusion on 10.5 months (mean) and 8 months (median) angiographic follow-up remained significant: LVIS 84%, 251/299; NEU 78%, 117/150; EP 67%, 83/123; P=0.004. There were 7% (47/670) intra-procedural complications and 11.5% (73/632) post-procedural-related complications in our cohort. Furthermore, procedure-related complications were higher in the braided-stents vs laser-cut, P=0.002.

Conclusions There was a great variability in techniques and choice of stent type for stent-assisted coiling among the participating centers. The type of stent was associated with immediate and long-term angiographic outcomes. Randomized prospective trials comparing the different types of stents are warranted.

  • aneurysm
  • coil
  • device
  • intervention

https://doi.org/10.1136/neurintsurg-2019-015182

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    Footnotes

    • Contributors MM, AT: study concept and design. MM, AT, and CTP wrote the manuscript. MM, AT, and CTP: statistical analysis. All authors participated in data collection and analysis, edited the manuscript, and approved the final version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests Mokin: reports consultant: Cerebrotech, Canon Medical, Imperative Care; stock options – Serenity Medical, Inc. Fiorella: reports grants, non-financial support, and other from Penumbra; non-financial support and other from Cerenovous and Medtronic; grants and non-financial support from Siemens and Microvention; and stock in Vascular Simulations and Neurogami. Rai: reports other from Penumbra; and non-financial support from Microvention and Stryker. Mocco: reports other from Penumbra, Cerebrotech, Rebound Therapeutics, TSP, Lazarus Effect, Medina, Pulsar Vascular, and Blockade. DeLeacy: reports other and non-financial support from Penumbra; and non-financial support from Cerenovus and Siemens. Turner: consultant for Penumbra, Medtronic, Microvention, Codman, Pulsar Vascular, Q’Apel, Rebound Medical, and Blockade Medical. Guilherme Dabus is a consultant for Medtronic, Microvention, and Penumbra and a shareholder in Surpass/Stryker, InNeuroCo, and Medina/Medtronic. Chaudry: reports other, grants, and non-financial support from Penumbra and Pulsar Vascular; grants and non-financial support from Medtronic, Microvention, and Codman; non-financial support and other from Blockade and non-financial support from Siemens. Turk: reports other, grants, and non-financial support from Penumbra and Pulsar Vascular; grants and non-financial support from Codman, Microvention, and Medtronic; non-financial support and other from Blockade; and non-financial support from Siemens.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.