Effect of stenting on progressive occlusion of small unruptured saccular intracranial aneurysms with residual sac immediately after coil embolization: a propensity score analysis.
BACKGROUND
To examine the effect of stenting on progressive occlusion of small and incompletely occluded unruptured intracranial aneurysms (UIAs) ≤10 mm in size using a propensity score matched case controlled analysis.


METHODS
715 small UIAs consecutively treated by coiling between 2008 and 2010 were eligible for study. Time of flight MR angiography and/or catheter angiography were used to estimate extent of occlusion after coiling. Complete occlusion at 6 months post embolization of a sac filled with contrast immediately after coiling constituted progressive occlusion. A propensity score matched analysis was conducted, based on the probability of stent deployment.


RESULTS
206 (28.8%) small UIAs showed residual sac filling directly after coiling. Of these, 182 (88.3%) displayed progressive occlusion at 6 months. Aneurysm size (p<0.01), neck size (p<0.01), and embolization attempt (p<0.01) differed significantly for stented and non-stented lesions, but the incidence of progressive occlusion did not differ (p=0.78) between the groups. After 1:1 propensity score matching, however, the rate of complete occlusion in stented subjects (97.5%) surpassed that of the non-stented counterparts (OR=9.75, p=0.01).


CONCLUSIONS
Small UIAs with residual sac filling after coiling showed a complete occlusion rate of 88.3% at 6 months post embolization. Stent deployment seems to promote complete occlusion in such lesions.
Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea.
Jin Pyeong
JP
Jeon
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Young Dae
YD
Cho
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Jong Kook
JK
Rhim
Department of Radiology, Sungkyunkwan University College of Medicine, Seoul, Korea.
Jeong Jin
JJ
Park
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Won-Sang
WS
Cho
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Hyun-Seung
HS
Kang
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Jeong Eun
JE
Kim
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Moon Hee
MH
Han
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D060205:Therapeutic Occlusion / Q000379:methods*; D016896:Treatment Outcome
Aneurysm; Angiography; Stent