Comparison of Stent-Assisted Coiling vs Coiling Alone in 563 Intracranial Aneurysms: Safety and Efficacy at a High-Volume Center

BACKGROUND:Stent-assisted coiling has been used in both unruptured and ruptured aneurysms, but the safety and efficacy still remain controversial. OBJECTIVE:To compare the safety and efficacy of stent-assisted coiling with coiling alone for intracranial aneurysms. METHODS:We retrospectively reviewed 512 patients treated by endovascular coiling or stent-assisted coiling over a 1-year period. The patientsʼ clinical and imaging information was recorded. Procedure-related complication rates, recurrence rates, and clinical outcomes were analyzed in both the total aneurysms and the subgroups of ruptured and unruptured aneurysms. RESULTS:A total of 243 patients were treated by coiling alone and 269 patients were treated by stent-assisted coiling. Procedure-related complications occurred in 6.2% of patients in the coiling-alone group compared with 6.3% in the stent-assisted coiling group. The procedural permanent morbidity and mortality rates were 1.6% (4/243) and 1.2% (3/243), respectively, in the coiling-alone group and 1.1% (3/269) and 1.5% (4/269), respectively, in the stent-assisted coiling group. A significantly lower recurrence rate was found in the stent-assisted coiling group compared with the coiling-alone group (5.2% vs 16.5%, P = .002). In a comparison of subgroups of ruptured and unruptured aneurysms, the procedural complications rates were comparable in the 2 groups, with a lower recurrence rate in the stent-assisted coiling group. Multivariate analysis showed that larger aneurysm size and higher Hunt and Hess grade were predictors of procedural morbidity; larger aneurysm size, ruptured aneurysm, anterior circulation aneurysms, initial incomplete occlusion, and lack of stent assistance were predictors of recurrence. CONCLUSION:Compared with coiling alone, stent-assisted coiling may achieve lower recurrence rates, with comparable procedure-related complications and clinical outcomes in both ruptured and unruptured aneurysms. ABBREVIATIONS:HH, Hunt and HessmRS, modified Rankin Scale