title: Peri-procedural morbidity and mortality associated with stent-assisted coiling for intracranial aneurysms.
abstract: Despite experience and technological improvements, stent-assisted coiling for intracranial aneurysms still has inherent risks. We evaluated peri-procedural morbidity and mortality associated with stent-assisted coiling for intracranial aneurysms. Patients with cerebral aneurysms that were broad-based (>4 mm) or had unfavorable dome/neck ratios (<1.5) were enrolled in this study between February and November 2011 at our center. Aneurysms were treated with the self-expanding neurovascular stents with adjunctive coil embolization. Seventy-two consecutive patients (27 men and 45 women; 22-78 years of age; mean age, 52.8 years) underwent 13 procedures for 13 ruptured aneurysms and 64 procedures for 73 unruptured aneurysms. Nine [11.7%, 95%CI(4.5%-18.9%)] procedure-related complications occurred: one and eight with initial embolization of ruptured and unruptured aneurysms, respectively. Complications included six acute in-stent thromboses, one spontaneous stent migration, one post-procedural aneurysm rupture, and one perforator occlusion. Three complications had no neurologic consequences. Two caused transient neurologic morbidity, two persistent neurologic morbidity, and two death. Procedure-related neurologic morbidity and mortality rates, respectively, were as follows: overall, 5.2% (95%CI, 0.2%-10.2%) and 2.6% (95%CI, 0%-6.2%); ruptured aneurysms, 7.7% (95%CI, 0%-36%) and 0%(95%CI, 0%-25%); unruptured aneurysms, 4.7% (95%CI, 0%-9.9%) and 3.1% (95%CI, 0%-7.3%). Combined procedure-related morbidity and mortality rates for ruptured and unruptured aneurysms were 7.7% (95%CI, 1.7%-13.7%) and 7.8% (95%CI, 1.8%-13.8%), respectively. Stent-assisted coiling is an attractive option for intracranial aneurysms. However, stent-assisted coiling for unruptured aneurysms is controversial for its comparable risk to natural history.
authors.affiliation: Department of Neurosurgery, Wendeng Center Hospital of Weihai, The affiliated Hospital Weifang Medical College, Weihai, Shandong, China.
authors.forename: K
authors.initials: K
authors.lastname: Wang
authors.forename: Y
authors.initials: Y
authors.lastname: Sun
authors.forename: A-M
authors.initials: AM
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000401:mortality; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D005548:Foreign-Body Migration / Q000401:mortality; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality* / Q000628:therapy*; D020767:Intracranial Thrombosis / Q000401:mortality; D007431:Intraoperative Complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data*; D055815:Young Adult