Clinical and angiographic outcomes of stent-assisted coiling of intracranial aneurysms

Diana Ghinda; Marlise Peruzzo Dos Santos; Armin Sabri; Daniela Iancu; Cheemun Lum; Howard J Lesiuk

doi:10.1177/1591019915582152

Clinical and angiographic outcomes of stent-assisted coiling of intracranial aneurysms

Interv Neuroradiol. 2015 Apr;21(2):146-54. doi: 10.1177/1591019915582152. Epub 2015 May 7.

Authors

Diana Ghinda¹, Marlise Peruzzo Dos Santos², Armin Sabri³, Daniela Iancu⁴, Cheemun Lum⁴, Howard J Lesiuk¹

Affiliations

¹ Department of Neurosurgery, The Ottawa Hospital, University of Ottawa, Canada.
² Neuroradiology Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Canada; Ottawa Hospital Research Institute, Canada msantos@toh.on.ca.
³ Department of Medical Imaging, University of Ottawa, Canada.
⁴ Neuroradiology Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Canada; Ottawa Hospital Research Institute, Canada.

Abstract

Background: Despite the increasing use of stent-assisted coiling (SAC), data on its long-term clinical and angiographic results are limited.

Objective: The objective of this article is to assess the long-term clinical and angiographic outcomes in SAC in our single-center practice.

Methods: We conducted a retrospective analysis of intracranial aneurysms treated with detachable coils during the period 2003-2012. Patients were divided into SAC and non-SAC groups and were analyzed for aneurysm occlusion, major recurrence and clinical outcome. Logistic regression analyses identified factors associated with clinical/angiographic outcomes (p value <0.05 was statistically significant).

Results: A total of 516 procedures met inclusion criteria: Sixty-three (12.2%) patients underwent SAC, of whom 56 (89%) had an elective procedure whereas 286 (63.1%) aneurysms from the non-SAC group were ruptured. In the unruptured subcohort, baseline class I was achieved in 24 (38%, p = 0.91), and predischarge modified Rankin scale score (mRS) 0-2 was obtained in 96.4% of cases in the SAC group versus 90.4% in the non-stent group. The major recurrence was 9.5% versus 11.3% in the SAC and non-SAC group, respectively (p = 0.003). At last clinical assessment, 98.2% of the patients from the unruptured SAC group had mRS 0-2 (mean follow-up, 58 months) versus 93.6% (mean follow-up, 56 months) in the unruptured non-SAC group (p = 0.64). Periprocedural vasospasm was associated with long-term poor outcome in the unruptured SAC subcohort (p = 0.0008).

Conclusions: SAC and non-SCA techniques show comparable safety and clinical outcome. The SAC technique significantly decreases retreatment rates. Periprocedural vasospasm resulting from vessel manipulation is associated with poor outcome in SAC of unruptured aneurysms.

Keywords: Intracranial aneurysm; aneurysm; clinical outcome; endovascular treatment; outcome; recanalization; recurrence; stent-assisted coiling; vasospasm.

MeSH terms

Adult
Aged
Angiography, Digital Subtraction
Cerebral Angiography
Embolization, Therapeutic
Endovascular Procedures / adverse effects
Endovascular Procedures / methods*
Female
Humans
Intracranial Aneurysm / diagnostic imaging
Intracranial Aneurysm / surgery*
Magnetic Resonance Angiography
Male
Middle Aged
Neurosurgical Procedures / adverse effects
Neurosurgical Procedures / methods*
Recurrence
Retrospective Studies
Risk Factors
Stents* / adverse effects
Treatment Outcome
Vasospasm, Intracranial / complications