title: Stent-Assisted Coil Embolization of Intracranial Aneurysms: Complications in Acutely Ruptured versus Unruptured Aneurysms.
abstract: OBJECTIVE
  The use of stents in the setting of SAH is controversial because of concerns about the efficacy and risk of dual antiplatelet therapy. We compare complications of stent-assisted coil embolization in patients with acutely ruptured aneurysms with complications in patients with unruptured aneurysms.
  
  
  METHODS
  Between February 2007 and March 2015, 45 acutely ruptured aneurysms and 47 unruptured aneurysms were treated with stent-assisted coiling. Patients with ruptured aneurysms were not pretreated with antiplatelet medication but received intravenous aspirin during the procedure. Thromboembolic events and early rebleeds were recorded.
  
  
  RESULTS
  In ruptured aneurysms, 9 of 45 patients had thromboembolic complications. Four patients remained asymptomatic, 4 developed infarctions, and 1 patient died. The permanent complication rate in ruptured aneurysms was 11% (95% CI, 4%-24%). Five of 45 patients (11%; 95% CI, 4%-24%) had an early rebleed from the treated aneurysm after 3-45 days, and in 4, this rebleed was fatal. In 46 patients with 47 unruptured aneurysms, thromboembolic complications occurred in 2. One patient remained asymptomatic; the other had a thalamus infarction. The complication rate in unruptured aneurysms was 2.2% (1 of 46; 95% CI, 0.01%-12%). No first-time hemorrhages occurred in 46 patients with 47 aneurysms during 6 months of follow-up.
  
  
  CONCLUSIONS
  The complication rate of stent-assisted coiling with early adverse events in ruptured aneurysms was 10 times higher than that in unruptured aneurysms. Early rebleed accounted for most mortality. In ruptured aneurysms, stent-assisted coil embolization is associated with increased morbidity and mortality and should only be considered when less risky options have been excluded.
authors.affiliation: From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands.
authors.forename: R S
authors.identifier: http://orcid.org/0000-0002-8674-6326
authors.initials: RS
authors.lastname: Bechan
authors.affiliation: Academisch Medisch Centrum (M.E.S., C.B.M.), Amsterdam, the Netherlands.
authors.forename: M E
authors.identifier: http://orcid.org/0000-0001-6895-1353
authors.initials: ME
authors.lastname: Sprengers
authors.affiliation: Academisch Medisch Centrum (M.E.S., C.B.M.), Amsterdam, the Netherlands.
authors.forename: C B
authors.identifier: http://orcid.org/0000-0002-7600-9568
authors.initials: CB
authors.lastname: Majoie
authors.affiliation: From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands.
authors.forename: J P
authors.identifier: http://orcid.org/0000-0002-5957-9091
authors.initials: JP
authors.lastname: Peluso
authors.affiliation: From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-3949-5958
authors.initials: M
authors.lastname: Sluzewski
authors.affiliation: From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands wjjvanrooij@gmail.com.
authors.forename: W J
authors.identifier: http://orcid.org/0000-0001-5931-1186
authors.initials: WJ
authors.lastname: van Rooij
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D015607:Stents / Q000009:adverse effects; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology