title: Complication analysis in nitinol stent-assisted embolization of 486 intracranial aneurysms.
abstract: OBJECTIVE
  Stent-assisted embolization (SAE) has broadened the scope of endovascular cerebral aneurysm treatment. The risks associated with stent selection and configuration are poorly defined. In this study, the authors aimed to characterize the risk factors that contribute to complications in SAE of intracranial aneurysms.
  
  
  METHODS
  Over a 10-year period, a single surgeon treated 486 aneurysms with SAE in which open-cell Neuroform or closed-cell Enterprise stents were used. Single stents were used in 386 cases, overlapping stents were deployed in 80 cases, and Y-configuration stents were used in the remaining 20 cases. All neurological complications, which included transient deficits, were analyzed; disabling strokes and death were considered major complications. The chi-square test and multivariate logistic regression were used to evaluate the influence of aneurysm size and morphology, aneurysm location, stent selection, and stent configuration on complication rates.
  
  
  RESULTS
  There were 7 deaths (1.4%), 9 major strokes (1.9%), and 18 minor neurological complications (3.7%). For all complications, multivariate analysis revealed that large aneurysm size (10-25 mm; p = 0.01), giant aneurysm size (> 25 mm; p = 0.04), fusiform aneurysm morphology (p = 0.03), and using a Y-configuration stent (p = 0.048) were independent risk factors. For the major complications, independent risk factors included an aneurysm in the posterior circulation (p = 0.02), using an overlapping stent configuration (p = 0.03), and using a Y-configuration stent (p < 0.01).
  
  
  CONCLUSIONS
  In this series, SAE for cerebral aneurysm treatment carried an acceptable complication rate. With continued innovations in techniques and devices and with increased experience, the complication rates associated with SAE may be even lower in the future.
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago; and.
authors.forename: Andrew Kelly
authors.initials: AK
authors.lastname: Johnson
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago; and.
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Munich
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago; and.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Tan
authors.affiliation: Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Daniel Mark
authors.initials: DM
authors.lastname: Heiferman
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago; and.
authors.forename: Kiffon Marie
authors.initials: KM
authors.lastname: Keigher
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago; and.
authors.forename: Demetrius Klee
authors.initials: DK
authors.lastname: Lopes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000497:Alloys; C013616:nitinol
keywords: DSA = digital subtraction angiography; Enterprise; MRA = MR angiography; Neuroform; OR = odds ratio; SAE = stent-assisted embolization; SASN = small aneurysm, small neck; SAWN = small aneurysm, wide neck; Y stent; aneurysm; endovascular; stent; vascular disorders