Long-term angiographic outcome of stent-assisted coiling compared to non-assisted coiling of intracranila saccular aneurysms

Abstract

Aim: To compare angiographic result at long-term followup, and rates of progressive occlusion, recurrence, and retreatmentof stent-assisted coiled (SAC) and non-assistedcoiled (NAC) intracranial saccular aneurysms. Methods: Retrospective evaluation of department recordsidentified 260 patients with 283 saccular intracranial aneurysmswho had long-term angiographic follow-up (morethan 12 months) and were successfully treated with SAC(89 aneurysms) or NAC (194 aneurysms) at the University Hospital Center Zagreb from June 2005 to July 2012. Initialand control angiographic results in both groups weregraded using Roy/Raymond scale, converted to descriptiveterms, and the differences between them were evaluatedfor statistical significance. A multivariate analysis wasperformed to identify factors related to progression of aneurysmocclusion and recurrence at follow-up, and thoserelated to aneurysm retreatment. Results: There were more progressively occluded aneurysmsin SAC group (38 of 89 aneurysms, 42.7%) than inNAC group (46 of 194, 23.7%) (P = 0.002), but there wereno significant differences in the rates of recanalization, regrowth, and stable result. Multivariate logistic regressionidentified the use of stent as the most important factor associatedwith progressive occlusion (P = 0.015, odds ratio2.22, 95% confidence interval 1.17-4.21), and large aneurysmsize and posterior circulation location as most predictiveof aneurysm recurrence and retreatment. Conclusion: The use of stent is associated with delayed occlusionof initially incompletely coiled aneurysms duringfollow-up, but does not reduce the rate of recurrence andretreatment compared to coiling alone. Long-term angiographicfollow-up is needed for both SAC and NAC aneurysms.