title: Treatment of ruptured intracranial aneurysms: comparison of stenting and balloon remodeling.
abstract: BACKGROUND
  Stent-assisted coiling (SAC) and balloon-assisted coiling (BAC) are 2 well-established techniques for the treatment of complex and wide-necked intracranial aneurysms. Most clinicians are reluctant to perform SAC in the setting of subarachnoid hemorrhage because of the need for dual antiplatelet therapy.
  
  
  OBJECTIVE
  To compare the safety and efficacy of SAC and BAC in acutely ruptured complex and wide-necked aneurysms.
  
  
  METHODS
  Forty-four patients underwent SAC and 40 underwent BAC. Patients treated with SAC received antiplatelet medications. Perioperative adverse events and outcomes at follow-up (mean, 7.4 months) were retrospectively studied.
  
  
  RESULTS
  The 2 groups were statistically comparable with respect to all baseline characteristics except for older age in SAC patients (65.6 vs 56.5 years; P = .009). A higher proportion of SAC patients also had poor Hunt and Hess grades (III-V; 70.5% vs 55%; P = .l4). Hemorrhagic, thromboembolic, and overall procedural complications occurred in 6.8%, 11.4%, and 18.2% of the SAC group vs 2.5%, 7.5%, and 10% of the BAC group, respectively (P = .5, P = .6, P = .3, respectively). Favorable outcomes (modified Rankin Scale score 0-2) at follow-up were seen in 61.0% of the SAC group vs 77% of the BAC group (P = .1). In multivariable analysis, after controlling for differences in baseline characteristics, the type of treatment was not a predictor of procedural complications or clinical outcome.
  
  
  CONCLUSIONS
  In this study, procedural complications and clinical outcomes did not differ significantly between SAC and BAC in patients with acutely ruptured aneurysms. SAC may be an acceptable alternative to BAC for complex aneurysms in the acute phase of subarachnoid hemorrhage.
authors: Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania 19107, USA.
authors: Rohan
authors: R
authors: Chitale
authors: Nohra
authors: N
authors: Chalouhi
authors: Thana
authors: T
authors: Theofanis
authors: Robert M
authors: RM
authors: Starke
authors: Peter
authors: P
authors: Amenta
authors: Pascal
authors: P
authors: Jabbour
authors: Stavropoula
authors: S
authors: Tjoumakaris
authors: Aaron S
authors: AS
authors: Dumont
authors: Robert H
authors: RH
authors: Rosenwasser
authors: L Fernando
authors: LF
authors: Gonzalez
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D021721:Balloon Occlusion; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome