Abstract
Introduction: Clinicians still disagree about whether stent-assisted coil embolization (SAC) should be used to treat intracranial ruptured aneurysms in the acute stage. In the present series, we analyzed the clinical results of SAC in acutely ruptured cerebral aneurysms that were treated using a stent-assisted technique.
Materials and Methods: 101 consecutive patients with 126 acutely ruptured aneurysms were treated using endovascular therapy in our department between September 2014 and February 2019. The clinical outcomes were compared between SAC (S) and non-SAC (nS) groups.
Results: The patients’ characteristics were as follows: male/female, 30/71; average age, 63.9 years (range, 38-95 years); World Federation of Neurosurgeons (WFNS) grade IV and V (59.4%). Nineteen patients (18.8%) were treated using SAC; the other 82 were treated using simple coil embolization. In the S group, dual or triple antiplatelet medication through a gastric tube was started before stent deployment. Stents were deployed to cover the wide neck of the aneurysms in nine cases. In six cases, stents were deployed to preserve important branching arteries. In one case, the stent was deployed to treat fusiform aneurysms. In another case, the stent was deployed to divert flow. In two cases, the stent was deployed to secure the migrated coils from the aneurysms. Regarding the types of aneurysm in the SAC group, 10 were saccular type, seven dissection type, and two fusiform type. Seven aneurysms were located at the internal carotid artery, Three at the anterior communicating artery, two at the middle cerebral artery, one at the posterior cerebral artery, and six at the vertebrobasilar artery. The average aneurysm neck size was significantly different between the S and nS groups (5.0 mm vs. 3.3 mm, respectively; p = 0.0124). Perioperative complications occurred in 10/19 patients in the S group and in 11/82 patients in the nS group (p = 0.0005). In the S group, five aneurysms were thromboembolic complications, two were stent occlusions (one in the acute period and one in the late period), two were re-bleeds of aneurysms that occurred between 24 hours and 5 days after the procedure, and one was a cerebral hemorrhage. The morbidity and mortality rate was 21.1% (4/19) in the S group and 4.9% (4/82) in the nS group (p = 0.0391).
Conclusion: Although SAC carries a higher complication rate than non-SAC in patients with acute subarachnoid hemorrhage (SAH), it can be an alternative treatment if other options are hindered by poor grade, older age, or surgical difficulty.
