Study Supports Stent-Assisted Coiling of Intracranial Aneurysms

May 1, 2013—Findings from an analysis of stent-assisted coiling of intracranial aneurysms in 508 patients at a single center were published by Nohra Chalouhi, MD, et al in Stroke (2013;44:1348–1353).

The investigators noted that self-expanding stents are increasingly used for treatment of complex intracranial aneurysms. They conducted the study to assess the safety and efficacy of intracranial stenting and to determine predictors of treatment outcomes.

According to the study abstract in Stroke, a total of 508 patients with 552 aneurysms were treated with stents between 2006 and 2011 at Thomas Jefferson University Hospital in Philadelphia. A multivariate analysis was conducted to identify predictors of complications, recanalization, and outcome.

The devices used were the Neuroform microdelivery stent system (Stryker Corporation [Kalamazoo, MI], which acquired the device with the neurovascular business of Boston Scientific Corporation [Natick, MA] in October 2010) and the Codman Enterprise vascular reconstruction device and delivery system (Codman Neurovascular, Inc., a unit of Codman & Shurtleff, Inc. [Raynham, MA]).

As summarized in Stroke, 461 (91%) of the 508 patients were treated electively and 47 (9%) patients were treated in the setting of subarachnoid hemorrhage. Complications occurred in 6.8% of patients. In multivariate analysis, subarachnoid hemorrhage, delivery of coils before stent placement, and carotid terminus/middle cerebral artery aneurysm locations were independent predictors of procedural complications. Angiographic follow-up was available for 87% of patients at a mean of 26 months.

The investigators reported that the rates of recanalization and retreatment were 12% and 6.4%, respectively. Older age, previously coiled aneurysms, larger aneurysms, incompletely occluded aneurysms, Neuroform stent, and aneurysm location were predictors of recanalization. Favorable outcomes were seen in 99% of elective patients and 51% of subarachnoid hemorrhage patients. Patient age, ruptured aneurysms, and procedural complications were predictors of outcome.

The investigators concluded that stent-assisted coiling of intracranial aneurysms is safe, effective, and provides durable aneurysm closure. Higher complication rates and worse outcomes are associated with treatment of ruptured aneurysms. Stent delivery before coil deployment reduces the risk of procedural complications. Staging the procedure may not improve procedural safety. Closed-cell stents are associated with significantly lower recanalization rates, according to the investigators in Stroke.