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    Original Research

    Stent-assisted Coil Placement for the Treatment of 211 Acutely Ruptured Wide-necked Intracranial Aneurysms: A Single-Center 11-Year Experience

    Published Online:Mar 30 2015https://doi.org/10.1148/radiol.2015140974
    Correction(s) for this article

    Abstract

    In our series of 211 patients with acutely ruptured wide-necked aneurysms, the results achieved by using stent-assisted coil placement were comparable to those reported by using simple coil placement or balloon-assisted coil placement.

    Purpose

    To evaluate the safety and angiographic and clinical outcome of stent-assisted coil placement (SACP) for acutely ruptured wide-necked intracranial aneurysms treated in a single center during an 11-year period.

    Materials and Methods

    According to an institutional review board–approved protocol, the angiographic and clinical data of 211 patients (52 men, 159 women; median age, 56 years; age range, 31–83 years) with acutely ruptured wide-necked intracranial aneurysms (neck > 4 mm and/or dome-to-neck ratio ≤ 2) treated with SACP from September 2000 to December 2011 were reviewed retrospectively. Baseline characteristics, procedure-related complications, angiographic follow-up results, and clinical outcome were analyzed statistically. A Mann-Whitney U test was performed for non–normally distributed continuous variables. A Pearson χ2 or Fisher exact test was performed for categorical variables. Univariate analysis and logistic regression analysis were performed to determine the association of procedure-related complications and clinical outcome with potential risk factors.

    Results

    Procedure-related complications occurred in 30 patients (14.2%). They were more common in the anterior communicating artery (26.7%, 12 of 45) and middle cerebral artery bifurcation (40%, four of 10) aneurysms than in aneurysms at other locations (9.0%, 14 of 156). Clinical outcome (median, 33 months) was good in 175 patients (82.9%) with a modified Rankin Scale score of up to 2. Older age (P = .013, odds ratio = 1.054) and higher Hunt and Hess grade (P < .001, odds ratio = 15.876) were independent risk factors for unfavorable outcome. One hundred fifty-two of 190 patients who survived (80%) underwent angiographic follow-up at least once (median, 12 months). The complete occlusion rate improved from an immediate 45.5% to 75.7% at follow-up (115 of 152 patients).

    Conclusion

    Angiographic and clinical outcomes in our series were comparable to those reported by using coil placement alone or balloon-assisted coil placement techniques. SACP for the treatment of acutely ruptured middle cerebral artery bifurcation and anterior communicating artery aneurysms was associated with a significantly higher incidence of complications than was the case for treatment of aneurysms at other locations.

    © RSNA, 2015

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    Article History

    Received April 24, 2014; revision requested June 6, 2014; revision received October 30; accepted December 11; final version accepted January 15, 2015.
    Published online: Mar 30 2015
    Published in print: Aug 2015