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Original research
Stent-assisted coiling versus coiling alone of poor-grade ruptured intracranial aneurysms: a multicenter study
  1. Bing Zhao1,2,
  2. Xianxi Tan1,
  3. Hua Yang3,
  4. Kuang Zheng1,
  5. Zequn Li1,
  6. Ye Xiong1,
  7. Ming Zhong1
  8. on behalf of AMPAS study group
    1. 1Department of Neurosurgery, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China
    2. 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
    3. 3Department of Neurosurgery, The affiliated hospital of Guizhou Medical University, Guiyang, China
    1. Correspondence to Dr Bing Zhao or Dr Ming Zhong, Department of Neurosurgery, The first affiliated Hospital of Wenzhou Medical University, Nanbai Xiang Town, Wenzhou 325000, China; drzhaobing{at} or zhongming158{at}


    Introduction Endovascular coiling is a valid treatment option for poor-grade ruptured aneurysms. However, little is known about stent-assisted coiling of poor-grade aneurysms.

    Objective To compare the safety and efficacy of stent-assisted coiling with coiling alone for poor-grade aneurysms.

    Methods Using multicenter data on poor-grade aneurysms, we performed a retrospective analysis of 131 consecutive patients treated with endovascular coiling within 14 days after ictus. Patients were split into two groups: stent-assisted coiling and coiling alone. Baseline characteristics, immediate angiographic results, perioperative complications, and clinical outcomes were compared between the two groups.

    Results Twenty-three (17.6%) patients were treated with stent-assisted coiling and 108 (82.4%) with coiling alone. There were no statistically significant differences in patient age, sex, clinical grade, Fisher grade, modified Fisher grade, aneurysm location, and size between the stent-assisted coiling and coiling alone groups. Intraprocedural aneurysm rupture, procedure-related ischemic complication, external ventricular drainage-related hemorrhagic complication, and symptomatic vasospasm did not differ between the two groups. Immediate angiographic results and clinical outcomes at discharge and at 6 and 12 months did not differ between the groups. Aneurysm rebleeding occurred in 4 (17.4%) patients after stent-assisted coiling compared with 2 (1.9%) patients after coiling alone (p<0.007). Multivariate analysis showed that incomplete aneurysm occlusion was independently associated with aneurysm rebleeding (p=0.016), and there was a trend toward aneurysm rebleeding after stent-assisted coiling (p=0.051).

    Conclusions Stent-assisted coiling of poor-grade aneurysms is feasible and safe compared with coiling alone. However, the hemorrhagic complication and aneurysm rebleeding may not be negligible.

    • Aneurysm
    • Coil
    • Stent
    • Complication

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    • Collaborators AMPAS study group: Hongqi Zhang, MD, Xuan Wu Hospital, Capital Medical University; Chuansheng Liang, MD, the first hospital of China Medical University; Huaizhang Shi, MD, the first affiliated hospital of Harbin Medical University; Jing Xu, MD, the second affiliated Hospital, School of Medicine, Zhejiang University; Li Pan, MD, Wuhan General Hospital of Guangzhou Command; Xin Zhang, MD, Nanjing General Hospital of Nanjing Command; Gang Zhu, MD, West South Hospital, the Third Military Medical University; Jianping Deng, MD, Tang Du Hospital, the Fourth Military Medical University; Zhigang Wang, MD, the second affiliated Hospital, School of Medicine, Shandong University.

    • Contributors BZ and MZ were principal investigators and had the idea for the study and protocol design. BZ, XT, HY, and MZ were involved in data analysis and implementation. BZ, KZ, ZL, and YX were involved in data collection, data verification, and data implementation. BZ drafted the manuscript. XT, HY, and MZ critically reviewed the manuscript. All authors read and approved the final manuscript.

    • Funding This work was supported by the Chinese Ministry of Health (grant WKJ2010-2-016), the Ministry of Science and Technology of China (grant 2011BAI08B06), and Wenzhou Bureau of Science and Technology (grant Y20090005).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The study was approved by the Chinese Ethics Committee of Registering Clinical Trials.

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