Stent-Assisted Coil Embolization of Intracranial Aneurysms: Complications in Acutely Ruptured versus Unruptured Aneurysms

AJNR Am J Neuroradiol. 2016 Mar;37(3):502-7. doi: 10.3174/ajnr.A4542. Epub 2015 Sep 24.

Abstract

Background and purpose: 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.

Materials and 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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aneurysm, Ruptured / therapy*
  • Blood Vessel Prosthesis
  • Embolization, Therapeutic / adverse effects*
  • Embolization, Therapeutic / instrumentation*
  • Embolization, Therapeutic / methods
  • Female
  • Humans
  • Intracranial Aneurysm / therapy*
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Stents / adverse effects
  • Thromboembolism / epidemiology
  • Thromboembolism / etiology