title: Stent-assisted Coil Placement for the Treatment of 211 Acutely Ruptured Wide-necked Intracranial Aneurysms: A Single-Center 11-Year Experience.
abstract: OBJECTIVE
  To evaluate the safety and angiographic and clinical outcome of stent-assisted coil placement (SACP) for acutely ruptured wide-necked intracranial aneurysms treated in a single center during an 11-year period.
  
  
  METHODS
  According to an institutional review board-approved protocol, the angiographic and clinical data of 211 patients (52 men, 159 women; median age, 56 years; age range, 31-83 years) with acutely ruptured wide-necked intracranial aneurysms (neck > 4 mm and/or dome-to-neck ratio ≤ 2) treated with SACP from September 2000 to December 2011 were reviewed retrospectively. Baseline characteristics, procedure-related complications, angiographic follow-up results, and clinical outcome were analyzed statistically. A Mann-Whitney U test was performed for non-normally distributed continuous variables. A Pearson χ(2) or Fisher exact test was performed for categorical variables. Univariate analysis and logistic regression analysis were performed to determine the association of procedure-related complications and clinical outcome with potential risk factors.
  
  
  RESULTS
  Procedure-related complications occurred in 30 patients (14.2%). They were more common in the anterior communicating artery (26.7%, 12 of 45) and middle cerebral artery bifurcation (40%, four of 10) aneurysms than in aneurysms at other locations (9.0%, 14 of 156). Clinical outcome (median, 33 months) was good in 175 patients (82.9%) with a modified Rankin Scale score of up to 2. Older age (P = .013, odds ratio = 1.054) and higher Hunt and Hess grade (P < .001, odds ratio = 15.876) were independent risk factors for unfavorable outcome. One hundred fifty-two of 190 patients who survived (80%) underwent angiographic follow-up at least once (median, 12 months). The complete occlusion rate improved from an immediate 45.5% to 75.7% at follow-up (115 of 152 patients).
  
  
  CONCLUSIONS
  Angiographic and clinical outcomes in our series were comparable to those reported by using coil placement alone or balloon-assisted coil placement techniques. SACP for the treatment of acutely ruptured middle cerebral artery bifurcation and anterior communicating artery aneurysms was associated with a significantly higher incidence of complications than was the case for treatment of aneurysms at other locations.
authors.affiliation: From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai 200433, People's Republic of China (P.Y., K.Z., Y.Z., R.Z., L.Z., W.Z., B.H., Y.X., Q.H., J.L.); and Division of Neuroradiology, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (T.K.).
authors.forename: Pengfei
authors.initials: P
authors.lastname: Yang
authors.affiliation: From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai 200433, People's Republic of China (P.Y., K.Z., Y.Z., R.Z., L.Z., W.Z., B.H., Y.X., Q.H., J.L.); and Division of Neuroradiology, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (T.K.).
authors.forename: Kaijun
authors.initials: K
authors.lastname: Zhao
authors.affiliation: From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai 200433, People's Republic of China (P.Y., K.Z., Y.Z., R.Z., L.Z., W.Z., B.H., Y.X., Q.H., J.L.); and Division of Neuroradiology, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (T.K.).
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai 200433, People's Republic of China (P.Y., K.Z., Y.Z., R.Z., L.Z., W.Z., B.H., Y.X., Q.H., J.L.); and Division of Neuroradiology, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (T.K.).
authors.forename: Rui
authors.initials: R
authors.lastname: Zhao
authors.affiliation: From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai 200433, People's Republic of China (P.Y., K.Z., Y.Z., R.Z., L.Z., W.Z., B.H., Y.X., Q.H., J.L.); and Division of Neuroradiology, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (T.K.).
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai 200433, People's Republic of China (P.Y., K.Z., Y.Z., R.Z., L.Z., W.Z., B.H., Y.X., Q.H., J.L.); and Division of Neuroradiology, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (T.K.).
authors.forename: Wenyuan
authors.initials: W
authors.lastname: Zhao
authors.affiliation: From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai 200433, People's Republic of China (P.Y., K.Z., Y.Z., R.Z., L.Z., W.Z., B.H., Y.X., Q.H., J.L.); and Division of Neuroradiology, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (T.K.).
authors.forename: Bo
authors.initials: B
authors.lastname: Hong
authors.affiliation: From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai 200433, People's Republic of China (P.Y., K.Z., Y.Z., R.Z., L.Z., W.Z., B.H., Y.X., Q.H., J.L.); and Division of Neuroradiology, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (T.K.).
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.affiliation: From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai 200433, People's Republic of China (P.Y., K.Z., Y.Z., R.Z., L.Z., W.Z., B.H., Y.X., Q.H., J.L.); and Division of Neuroradiology, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (T.K.).
authors.forename: Qinghai
authors.initials: Q
authors.lastname: Huang
authors.affiliation: From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai 200433, People's Republic of China (P.Y., K.Z., Y.Z., R.Z., L.Z., W.Z., B.H., Y.X., Q.H., J.L.); and Division of Neuroradiology, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (T.K.).
authors.forename: Timo
authors.initials: T
authors.lastname: Krings
authors.affiliation: From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai 200433, People's Republic of China (P.Y., K.Z., Y.Z., R.Z., L.Z., W.Z., B.H., Y.X., Q.H., J.L.); and Division of Neuroradiology, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (T.K.).
authors.forename: Jianmin
authors.initials: J
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery*; D000792:Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome