Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period: incidence of and risk factors for periprocedural complications.

Abstract

OBJECT.: The purpose of this study was to report the authors' experiences in

stent-assisted coil embolization (SAC) of ruptured wide-necked aneurysms in the

acute period and to evaluate the incidence of and risk factors for periprocedural

complications. METHODS: A total of 72 patients were recruited for this study

between March 2007 and June 2012. All patients met the following criteria: 1) the

presence of ruptured intracranial wide-necked saccular aneurysms, and 2) the

patient underwent SAC for treatment of those aneurysms within 72 hours of

rupture. All of the patients with clinically poor grades or acute hydrocephalus

underwent external ventricular drainage (EVD) before SAC. The incidence of and

risk factors for periprocedural complications were retrospectively evaluated.

RESULTS: Of the 72 patients included in this study, periprocedural complications

occurred in 14 (19.4%), including asymptomatic complications in 4 (5.6%) and

symptomatic complications in 10 (13.9%); there were symptomatic thromboembolic

complications in 5 patients (6.9%), and symptomatic hemorrhagic complications in

5 (6.9%). The authors observed no subacute or delayed thromboembolic

complications during the follow-up period of 18.8 months. Use of EVD (OR 1.413,

95% CI 0.088-2.173; p = 0.046) was the only independent risk factor for

periprocedural complications on multivariate logistic regression analysis.

CONCLUSIONS: The periprocedural complication rate during SAC was 19.4% among 72

patients. Because of the high complication rate, microsurgical clipping or

endovascular treatment with another technique (multiple-microcatheter or

balloon-assisted technique) may be a more appropriate option for first-line

treatment than SAC, especially in patients requiring EVD.