title: Comparison of techniques for stent assisted coil embolization of aneurysms.
abstract: BACKGROUND
  Stent assisted coiling (SAC) of aneurysms has been adopted with potential mechanical, hemodynamic and biologic properties imparting an advantage over coil embolization alone. The purpose of this investigation is to compare the various techniques of SAC at a single institution with regards to clinical, technical and angiographic complications and success.
  
  
  METHODS
  Patients who underwent SAC between 2003 and 2010 were identified. Clinical charts, procedures, angiographic and non-invasive radiological images were analyzed to determine the anatomical and procedural details and adverse events. Immediate post-procedural angiograms as well as follow-up imaging were studied to assess the degree of aneurysm occlusion.
  
  
  RESULTS
  260 aneurysms were identified. The 'coil through' technique was employed in 37.3%, 'balloon stent' in 36.2%, 'jailing' in 10.8% and the 'coil stent' technique in 7.7%. Overall rate of adverse events was higher with the 'coil stent' and 'jailing' techniques compared with the 'balloon stent' technique. The 'coil through' technique was associated with a significantly lower packing density (31.4±20%) than all other techniques ('coil stent' 45.4±22%, 'jailing' 42.2±20%, 'balloon stent' 44.3±22%). Among 'coil stent' patients, an initial Raymond class 1 was achieved in 40%, compared with 57% of 'jailing', 28% of 'coil through' and 63% of 'balloon stent' cases.
  
  
  CONCLUSIONS
  Balloon assisted coil embolization followed by adjunctive stent deployment across the aneurysm neck appears to be the superior technique among stent assisted coiling methods at our institution. It combines a lower rate of thrombotic and coil related complications with a high rate of complete occlusion on initial and follow-up imaging.
authors: Neurological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors: Alejandro M
authors: AM
authors: Spiotta
authors: Anne Marie
authors: AM
authors: Wheeler
authors: Saksith
authors: S
authors: Smithason
authors: Ferdinand
authors: F
authors: Hui
authors: Shaye
authors: S
authors: Moskowitz
mesh_terms: D021721:Balloon Occlusion / Q000009:adverse effects / Q000379:methods*; D016208:Databases, Factual; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000628:therapy*; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome