Stent-assisted coiling versus balloon remodeling of wide-neck aneurysms: comparison of angiographic outcomes

• Published in: American journal of neuroradiology : AJNR Vol. 34; no. 10; pp. 1987 - 1992
• Main Authors: Chalouhi, N, Starke, R M, Koltz, M T, Jabbour, P M, Tjoumakaris, S I, Dumont, A S, Rosenwasser, R H, Singhal, S, Gonzalez, L F
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01-10-2013
• Subjects: Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - epidemiology; Aneurysm, Ruptured - therapy; Balloon Occlusion - adverse effects; Balloon Occlusion - instrumentation; Balloon Occlusion - methods; Cerebral Angiography; Cerebral Hemorrhage - epidemiology; Cerebral Hemorrhage - etiology; Cerebral Infarction - epidemiology; Cerebral Infarction - etiology; Female; Follow-Up Studies; Humans; Interventional; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - epidemiology; Intracranial Aneurysm - therapy; Logistic Models; Male; Middle Aged; Morbidity; Multivariate Analysis; Predictive Value of Tests; Retreatment; Retrospective Studies; Stents; Treatment Outcome
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A3538

Stent-assisted coiling and balloon-assisted coiling are 2 well-established techniques for treatment of wide-neck intracranial aneurysms. A direct comparative analysis of angiographic outcomes with the 2 techniques has not been available. We compare the angiographic outcomes of wide-neck aneurysms treated with stent-assisted coiling versus balloon-assisted coiling.
A retrospective review was conducted on 101 consecutive patients treated at our institution, 69 with stent-assisted coiling and 32 with balloon-assisted coiling. Two multivariate logistic regression analyses were performed to determine predictors of aneurysm obliteration and predictors of progressive aneurysm thrombosis at follow-up.
The 2 groups were comparable with respect to all baseline characteristics with the exception of a higher proportion of ruptured aneurysms in the balloon-assisted coiling group (65.6%) than in the stent-assisted coiling group (11.5%, P < .001). Procedural complications did not differ between the stent-assisted coiling group (6%) and the balloon-assisted coiling group (9%, P = .5). The rates of complete aneurysm occlusion (Raymond score 1) at the most recent follow-up were significantly higher for the stent-assisted coiling group (75.4%) compared with the balloon-assisted coiling group (50%, P = .01). Progressive occlusion of incompletely coiled aneurysms was noted in 76.6% of aneurysms in the stent-assisted coiling group versus 42.8% in the balloon-assisted coiling group (P = .02). Retreatment rates were significantly lower with stent-assisted coiling (4.3%) versus balloon-assisted coiling (15.6%, P = .05). In multivariate analysis, stented aneurysms independently predicted both complete aneurysm obliteration and progression of occlusion.
Stent-assisted coiling may yield lower rates of retreatment and higher rates of aneurysm obliteration and progression of occlusion at follow-up than balloon-assisted coiling with a similar morbidity rate.