title: Comparison of the flow diverter and stent-assisted coiling in large and giant aneurysms: safety and efficacy based on a propensity score-matched analysis.
abstract: OBJECTIVE
  The flow diverter (FD) is a device aimed at reconstructing the parent artery and occluding an aneurysm. We performed a propensity score-matched analysis to compare safety and efficacy between the FD and stent-assisted coiling.
  
  
  METHODS
  A database review was conducted to identify patients with large and giant unruptured aneurysms (aneurysms located in the ACA, MCA, or PCA were excluded) treated with the FD or stent-assisted coiling. A propensity score, representing the probability of using the FD, was generated for each aneurysm using the relevant patient and aneurysmal variables. Angiographic results, complications, and clinical outcomes were compared.
  
  
  RESULTS
  Forty-five aneurysms treated with the FD (FD alone: 32; FD+Coils: 13) and 45 treated with stent-assisted coiling were matched. The rate of complete occlusion was significantly (P = 0.0002) higher in the FD cohort than the conventional stent cohort at the 6-month follow-up. The FD cohort achieved greater improvement (P < 0.0001) and a lower rate of recurrence (P = 0.0001). The rate of periprocedural complications was similar, as was the proportion of patients who attained mRS ≤ 2 at discharge and at the 6-month follow-up.
  
  
  CONCLUSIONS
  Our findings provide reliable evidence demonstrating that the FD may be a preferred treatment option for large and giant unruptured aneurysms.
  
  
  CONCLUSIONS
  • Flow Diverter provided a higher complete occlusion rate at 6-month follow-up. • Flow Diverter achieved more progress occlusion and less recurrence. • Compared with the conventional stents, procedure-related morbidity of Flow Diverter was similar. • Flow Diverter is a preferred treatment for large and giant unruptured aneurysms.
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
authors.forename: Yongxin
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
authors.forename: Bo
authors.initials: B
authors.lastname: Hong
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
authors.forename: Wenyuan
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Department of Health Statistics, Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, People's Republic of China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China. ocinhqh@163.com.
authors.forename: Qing-Hai
authors.initials: QH
authors.lastname: Huang
mesh_terms: D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Aneurysms; Comparative research; Flow diverter; Propensity score; Stent