Single-centre comparison of procedural complications,clinical outcome,and angiographic follow-up between coiling and stent-assisted coiling for posterior communicating artery aneurysms |
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| Affiliation: | 1. Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran;2. School of Medicine, Shahid Beheshti University of Medical Sciences, Daneshju Boulevard, Evin, Tehran, Iran;3. Department of Emergency Medicine, Shohadaye-Haftom Tir Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran;4. Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, MN, USA;1. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China;2. Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China;3. Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China;1. Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan;2. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan;3. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan;4. Department of Surgery, Kinki University School of Medicine, Sayama, Osaka, Japan;5. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan;1. Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Chongwen District, Beijing 100050, China;2. Department of Neurovascular Surgery, Chinese People’s Armed Police Force General Hospital, Haidian, Beijing, China;1. Department of Neurosurgery, Shantou Central Hospital, Shantou, Guangdong, China;2. Department of Neurology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China |
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| Abstract: | Aneurysm recurrence is a principle limitation of endovascular coiling procedures, especially in posterior communicating artery aneurysms, with reported recurrence rates of >30%. The adjunctive use of self-expandable stents has revolutionised the treatment of intracranial aneurysms, especially for complex morphologies, wide necks, or unfavourable dome-to-neck ratios. However, there are limited data concerning a direct comparison between simple coiling and stent-assisted coiling in posterior communicating artery aneurysms. This study aimed to compare the durability and outcomes of coiling versus stent-assisted coiling procedures. Imaging data of patients with posterior communicating artery aneurysms treated with coiling or stent-assisted coiling between January 2008 and October 2012 were retrospectively analysed. The initial angiographic results, procedural complications, and clinical outcomes were assessed at discharge. Imaging follow-up was performed with cerebral angiography. Complete aneurysm occlusion was achieved on initial angiography in 23/56 (41.1%) stent and 83/235 (35.3%) non-stent patients. At the latest follow-up (mean follow-up 14.3 ± 10.4 months for stent and 13.2 ± 9.5 months for non-stent patients), aneurysms had recurred in 5/47 (10.6%) stent and 57/203 (28.1%) non-stent patients (p = 0.014). Procedural complications occurred in 6/56 (10.7%) stent and 27/235 (11.5%) non-stent aneurysms. No rebleeding occurred during clinical follow-up (mean duration, 46.7 months). Recurrence rates at the latest follow-up were significantly lower in patients undergoing stent-assisted coiling than those undergoing simple coiling. Thus, use of the stent-assisted neck remodelling technique in the treatment of wide-necked posterior communicating artery intracranial aneurysms appears to improve the long-term clinical outcome. |
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| Keywords: | Endovascular treatment Intracranial aneurysm Posterior communicating artery aneurysm Stent-assisted coiling |
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