AUTHOR=Zhang Guanghao , Zhang Renkun , Wei Yanpeng , Chen Rundong , Zhang Xiaoxi , Xue Gaici , Lv Nan , Duan Guoli , Wang Chuanchuan , Yu Ying , Dai Dongwei , Zhao Rui , Li Qiang , Xu Yi , Huang Qinghai , Yang Pengfei , Zuo Qiao , Liu Jianmin 

TITLE=Comparison of staged-stent and stent-assisted coiling technique for ruptured saccular wide-necked intracranial aneurysms: Safety and efficacy based on a propensity score-matched cohort study

JOURNAL=Frontiers in Neurology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1101859

DOI=10.3389/fneur.2023.1101859

ISSN=1664-2295

ABSTRACT=<sec><title>Background</title><p>Application of stent-assisted coiling and FD in acute phase of ruptured wide-necked aneurysms is relatively contraindicated due to the potential risk of ischemic and hemorrhagic complications. Scheduled stenting after initial coiling has emerged as an alternative paradigm for ruptured wide-necked aneurysms. The objective of this study is to evaluate the safety and efficacy of a strategy of staged stent-assisted coiling in acutely ruptured saccular wide-necked intracranial aneurysms compared with conventional early stent-assisted coiling strategy <italic>via</italic> propensity score matching in a high-volume center.</p></sec><sec><title>Methods</title><p>A retrospective review of patients with acutely ruptured saccular wide-necked intracranial aneurysms who underwent staged stent-assisted coiling or conventional stent-assisted coiling from November 2014 to November 2019 was performed. Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared.</p></sec><sec><title>Results</title><p>A total of 69 patients with staged stent-assisted coiling and 138 patients with conventional stent-assisted coiling were enrolled after 1:2 propensity score matching. The median interval time between previous coiling and later stenting was 4.0 weeks (range 3.5–7.5 weeks). No rebleeding occurred during the intervals. The rate of immediate complete occlusion was lower with initial coiling before scheduled stenting than with conventional stent-assisted coiling (21.7 vs. 60.9%), whereas comparable results were observed at follow-up (82.5 vs. 72.9%; <italic>p</italic> = 0.357). The clinical follow-up outcomes, overall procedure-related complications and procedure-related mortality between the two groups demonstrated no significant differences (<italic>P</italic> = 0.232, <italic>P</italic> = 0.089, <italic>P</italic> = 0.537, respectively). Multivariate analysis showed that modified Fisher grades (OR = 2.120, <italic>P</italic> = 0.041) were independent predictors for overall procedure-related complications and no significant predictors for hemorrhagic and ischemic complications.</p></sec><sec><title>Conclusions</title><p>Staged stent-assisted coiling is a safe and effective treatment strategy for acutely ruptured saccular wide-necked intracranial aneurysms, with comparable complete occlusion rates, recurrence rates at follow-up and overall procedure-related complication rates compared with conventional stent-assisted coiling strategy. Staged stent-assisted coiling could be an alternative treatment option for selected ruptured intracranial aneurysms in the future.</p></sec>