Abstract
Introduction:
Self-expanding stents are increasingly used for treatment of complex intracranial aneurysms. We assess the safety and efficacy of intracranial stenting and determine predictors of complications, recanalization, and outcome in the largest series of intracranial aneurysms to date.
Methods:
A total of 509 patients were treated with Neuroform and Enterprise stents between 2005-2011 in our institution. A multivariate logistic regression analysis was conducted to detect predictors of complications, recanalization, and outcome.
Results:
445 (87.4%) patients were treated electively and 64 (12.6%) in the setting of subarachnoid hemorrhage. Mean aneurysm size was 7.7 mm. Stent placement was successful in 97.6% of patients. The Neuroform stent was used in 56.8% and the Enterprise stent in 43.2%. Complete or near-complete aneurysm occlusion was achieved initially in 87.7% of cases. Procedural complications occurred in 5.6% of patients. In multivariate analysis, subarachnoid hemorrhage (p=0.03), delivery of coils prior to stent placement (p=0.002), and carotid terminus/middle cerebral artery aneurysm locations (p=0.01) were independent predictors of procedural complications. Angiographic follow-up was available for 85.1% of patients at a mean of 27 months. The rates of recanalization and retreatment were respectively 11.7% and 6.1%. Previously coiled aneurysms (p=0.02), ruptured aneurysms (p=0.01), larger aneurysms (p<0.001), incompletely occluded aneurysms (p=0.01), and cavernous/vertebrobasilar/posterior communicating/middle cerebral artery aneurysms (p=0.04) were predictors of recanalization. Favorable outcomes were seen in 99.3% of elective patients and 61% of subarachnoid hemorrhage patients. Patient age (p=0.03), Hunt and Hess Grades (p<0.001), and procedural complications (p<0.001) were predictors of outcome. The type of stent was not a predictor of complications, recanalization, or outcome.
Conclusion:
Stent-assisted coiling of ruptured and unruptured intracranial aneurysms is safe, effective, and provides durable aneurysm closure. Stent delivery prior to coil deployment reduces the risk of procedural complications. The type of stent used does not affect treatment outcome.