Introduction Early evidence suggests the safety of second- and third-generation intracranial stents in the treatment of intracranial aneurysms.

Aim of Study This two-centre trial aims to directly compare the low-profile Acclino stent (Acandis) – a second-generation stent – with the first-generation Enterprise stent (Johnson & Johnson/Cerenovus).

Methods Patients who received Enterprise or Acclino stents for unruptured aneurysms were followed for 8 years. Complications, clinical and angiographic outcomes were compared with the primary outcomes of ischaemic stroke incidence and mid-term occlusion rate. Propensity score adjustment adjusted for group differences.

Results Both Enterprise and Acclino stents were used in the same number of cases (48 each). The analysis showed a higher incidence of thromboembolic complications in the Enterprise group (20.8% vs. 4.2%, HR: 6.6, 95%CI: 2.2–20.0, p=0.01, adjusted p<0.01) and a higher rate of major ischaemic stroke (6.3% vs. 0%, HR: 2.1, 95%CI: 1.8–2.4, p=0.08, adjusted p<0.01). However, there were no significant differences in mid-term or long-term angiographic outcomes, with procedural success rates of 83.3% and 75.0% for Enterprise and 89.2% and 75.9% for Acclino (both p>0.05). Retreatment rates were 10.4% in the Enterprise group and 4.2% in the Acclino group (p=0.42, adjusted p=0.10).

Conclusion Advanced stents offer reduced thromboembolic risk and comparable aneurysm occlusion to first-generation stents due to their flexible design and surface modification. These results support the clinical use of advanced stent systems, but further comparative studies are needed to conclusively evaluate the efficacy of stent-assisted coiling with the Acclino stent and other systems.

Disclosure of Interest CK serves as consultants for Acandis GmbH (Pforzheim, Germany) and proctor for MicroVention Inc./Sequent Medical (Aliso Viejo, CA, USA). David Zopfs is on the speaker’s bureau of Philips (Amsterdam, the Netherlands) and lecturer for Amboss GmbH (Cologne, Germany). The other authors declare that they have no competing interests.