title: Safety and cost of stent-assisted coiling of unruptured intracranial aneurysms compared with coiling or clipping.
abstract: OBJECTIVE
  Stent-assisted coiling (SAC) of unruptured intracranial aneurysms is a treatment alternative to clipping or coiling, although high complication and procedure-related mortality rates have been reported.
  
  
  METHODS
  A retrospective study was conducted of patients undergoing SAC, coiling or clipping of unruptured intracranial aneurysms between 2003 and 2010. Rates of residual aneurysm, recanalization, complications, cost (adjusted to 2010), length of stay (LOS) and outcome were compared between groups.
  
  
  RESULTS
  Of 116 subjects, 47 underwent SAC, 33 coiling and 36 clipping. The groups were similar in age, gender and aneurysm location, although the SAC group had significantly larger aneurysms with wider necks (p=0.001). Patients who underwent SAC had more residual aneurysm after initial treatment than those treated with coiling or clipping (75%, 52% and 19%, respectively, p<0.0001), but this difference was smaller at follow-up angiography (50%, 50% and 17% residual, respectively) and was not significant after adjusting for baseline aneurysm and neck size. SAC was not associated with increased recanalization, requirement for additional treatment, mortality or complications after adjusting for aneurysm and neck size. Patients who underwent SAC and those who underwent coiling were more likely to have a good discharge disposition than patients treated with clipping (100% vs 91%, p=0.042). LOS was significantly shorter for patients who underwent SAC or coiling compared with those treated with clipping (p<0.0001). The overall direct cost was higher for patients who underwent SAC than for those treated with coiling or clipping (median $22 544 vs $12 933 vs $14 656, p=0.001), even after adjusting for aneurysm and neck size, LOS and retreatment.
  
  
  CONCLUSIONS
  SAC is a safe alternative to coiling or clipping of unruptured aneurysms but it is currently more expensive.
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Frontera
authors.forename: Joseph
authors.initials: J
authors.lastname: Moatti
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: de los Reyes
authors.forename: Stephen
authors.initials: S
authors.lastname: McCullough
authors.forename: Henry
authors.initials: H
authors.lastname: Moyle
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Bederson
authors.forename: Aman
authors.initials: A
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000191:economics; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000191:economics* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety / Q000191:economics*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects / Q000191:economics*; D013525:Surgical Instruments / Q000009:adverse effects / Q000191:economics*; D016896:Treatment Outcome; D055815:Young Adult