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New devices and techniques
Original research
A core-lab adjudicated analysis of single-stent assisted coiling of wide-neck bifurcation aneurysms
  1. Aliya Siddiqui1,
  2. Kyle M Fargen2,
  3. Justin E Vranic3,4,
  4. Aman B Patel5,
  5. Christopher S Ogilvy6,
  6. Ajith J Thomas7,
  7. Justin R Mascitelli8,
  8. Johanna T Fifi9,
  9. J Mocco10,
  10. Reade Andrew De Leacy9
    1. 1Mount Sinai Hospital, New York, New York, USA
    2. 2Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
    3. 3Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
    4. 4Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
    5. 5Massachusetts General Hospital, Boston, Massachusetts, USA
    6. 6Neurosurgery, BIDMC, Boston, Massachusetts, USA
    7. 7Cooper University Health Care, Camden, New Jersey, USA
    8. 8Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
    9. 9Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
    10. 10The Mount Sinai Health System, New York, New York, USA
    1. Correspondence to Dr Reade Andrew De Leacy, Neurosurgery, Icahn School of Medicine at Mount Sinai, New York NY 10029, New York, USA; reade.deleacy{at}mountsinai.org

    Abstract

    Background and purpose Core-lab adjudicated data regarding the efficacy of the single-stent assisted aneurysm coiling technique ‘L-stenting’ are lacking. We present a multicenter, core-lab adjudicated study evaluating the safety and effectiveness of single-stent assisted coiling in the treatment of wide-neck bifurcation aneurysms (WNBAs).

    Methods Consecutive patients who underwent L-stenting for WNBAs at three academic institutions between 2015 and 2019 were included in this retrospective study. Clinical safety and efficacy outcomes were gathered from the patient chart, and angiographic imaging was evaluated by core lab analysis. Safety and efficacy outcomes were summarized and predictors of safety and efficacy were calculated.

    Results Of 128 patients treated, 124 had angiographic outcome data at last follow-up. Of those, 110 had adequate (core-lab adjudicated modified Raymond Roy (mRR) score of 1 or 2) occlusion (88.7%). During follow-up, 19 patients (14.8%) required retreatment. There were 17 complications experienced in 12 patients: intraoperative (n=8, 6.25%), perioperative (n=5, 3.9%), or delayed (n=6; n=4 attributed to device/procedure, 3.1%). Significant predictors of complete occlusion were smaller aneurysm size and use of the jailing technique (P=0.0276). Significant predictors of retreatment were larger size, neck size, and larger dome to neck ratio (P=0.0008).

    Conclusion This study provides multicenter, core-lab adjudicated angiographic data regarding the efficacy of single-stent assisted coiling for WNBAs. This study acts as a validated comparator for future studies investigating novel devices or techniques for treating this challenging subgroup of aneurysms.

    • Stent
    • Aneurysm
    • Coil

    Data availability statement

    Data are available upon reasonable request. Please contact reade.deleacy@mountsinai.org for data.

    https://doi.org/10.1136/jnis-2023-020995

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      Data availability statement

      Data are available upon reasonable request. Please contact reade.deleacy@mountsinai.org for data.

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      Footnotes

      • X @jmascite, @rdeleacymd

      • Contributors The authors confirm contribution to the paper as follows: Guarantor: RDL; Study conception and design: RDL, AS; Data collection: AS, KMF, JEV, ABP, CSO, AJT, JRM, JTF, JM, RDL; Analysis and interpretation of results: AS, KMF, RDL; Draft manuscript preparation: AS, RDL. All authors reviewed the results and approved the final version of the manuscript.

      • 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 Philanthropic funding from Daniel and Nancy Paduano supported a research stipend for the study.

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

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.