title: Stent-assisted coiling versus coiling alone of poor-grade ruptured intracranial aneurysms: a multicenter study.
abstract: BACKGROUND
  Endovascular coiling is a valid treatment option for poor-grade ruptured aneurysms. However, little is known about stent-assisted coiling of poor-grade aneurysms.
  
  
  OBJECTIVE
  To compare the safety and efficacy of stent-assisted coiling with coiling alone for poor-grade aneurysms.
  
  
  METHODS
  Using multicenter data on poor-grade aneurysms, we performed a retrospective analysis of 131 consecutive patients treated with endovascular coiling within 14 days after ictus. Patients were split into two groups: stent-assisted coiling and coiling alone. Baseline characteristics, immediate angiographic results, perioperative complications, and clinical outcomes were compared between the two groups.
  
  
  RESULTS
  Twenty-three (17.6%) patients were treated with stent-assisted coiling and 108 (82.4%) with coiling alone. There were no statistically significant differences in patient age, sex, clinical grade, Fisher grade, modified Fisher grade, aneurysm location, and size between the stent-assisted coiling and coiling alone groups. Intraprocedural aneurysm rupture, procedure-related ischemic complication, external ventricular drainage-related hemorrhagic complication, and symptomatic vasospasm did not differ between the two groups. Immediate angiographic results and clinical outcomes at discharge and at 6 and 12 months did not differ between the groups. Aneurysm rebleeding occurred in 4 (17.4%) patients after stent-assisted coiling compared with 2 (1.9%) patients after coiling alone (p<0.007). Multivariate analysis showed that incomplete aneurysm occlusion was independently associated with aneurysm rebleeding (p=0.016), and there was a trend toward aneurysm rebleeding after stent-assisted coiling (p=0.051).
  
  
  CONCLUSIONS
  Stent-assisted coiling of poor-grade aneurysms is feasible and safe compared with coiling alone. However, the hemorrhagic complication and aneurysm rebleeding may not be negligible.
authors.affiliation: Department of Neurosurgery, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.|Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhao
authors.affiliation: Department of Neurosurgery, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Xianxi
authors.initials: X
authors.lastname: Tan
authors.affiliation: Department of Neurosurgery, The affiliated hospital of Guizhou Medical University, Guiyang, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Kuang
authors.initials: K
authors.lastname: Zheng
authors.affiliation: Department of Neurosurgery, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Zequn
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: Department of Neurosurgery, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhong
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Aneurysm; Coil; Complication; Stent