title: Analysis of complications and recurrences of aneurysm coiling with special emphasis on the stent-assisted technique.
abstract: OBJECTIVE
  Stent-assisted coiling has expanded the treatment of intracranial aneurysms. With the use of continuously compiled data, we reviewed the role and drawbacks of stent-assisted coiling.
  
  
  METHODS
  We compiled data from consecutive patients from 2003-2012 who underwent coiling, with or without stent assistance. Clinical and angiographic results were analyzed retrospectively.
  
  
  RESULTS
  Of 1815 saccular aneurysms in 1505 patients, 323 (17.8%) were treated with stents (299 procedures) and 1492 (82.2%) without stents (1400 procedures). Procedure-related complications occurred in 9.4% with stents versus 5.6% without stents (P = .016, relative risk 1.5; 95% CI, 1.1-2.7). Ischemic complications were more frequent in the stent group than in the no-stent group (7.0% versus 3.5%; P = .005; relative risk, 1.7; 95% CI 1.2-2.5), as were hemorrhagic complications (2.3% versus 1.9%, P = .64). Procedure-induced mortality occurred in 2.7% (8/299) with stents versus 1.1% (15/1400) without stents (P = .029; relative risk, 2.0; 95% CI, 1.1-3.5). Logistic regression analysis identified wide-neck aneurysms as the most significant independent predictor of complications. A total of 64.1% (207/323) of aneurysms treated with stents and 70.3% (1049/1492) treated without stents have been followed, disclosing angiographic recurrence in 15.5% (32/207) versus 35.5% (372/1049), respectively (P < .0001). Logistic regression analysis showed that the presence of a stent was the most important factor for the reduction of angiographic recurrence (P < .0001; relative risk, 2.3; 95% CI, 1.6-3.3).
  
  
  CONCLUSIONS
  The stent-assisted coiling technique is associated with a significant decrease in recurrences but a significant increase in complications. The treatment of wide-neck aneurysms remains hazardous.
authors.affiliation: From the Department of Interventional Neuroradiology, Foundation Rothschild Hospital, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Nishido
authors.forename: M
authors.initials: M
authors.lastname: Piotin
authors.forename: B
authors.initials: B
authors.lastname: Bartolini
authors.forename: S
authors.initials: S
authors.lastname: Pistocchi
authors.forename: H
authors.initials: H
authors.lastname: Redjem
authors.forename: R
authors.initials: R
authors.lastname: Blanc
mesh_terms: D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D061185:Mechanical Thrombolysis / Q000401:mortality*; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality*; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents / Q000706:statistics & numerical data*; D020521:Stroke / Q000000981:diagnostic imaging / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome
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