Stent-assisted coiling of acute ruptured cerebral aneurysms

Abstract

The necessity of quick surgical treatment of acute ruptured cerebral aneurysms was demonstrated in large studies by the ISAT and ISUIA, which also proved the advantage of the endovascular method over the surgical one. Ballonassistence is widely used in treatment of aneurysms with wide neck and unfavorable vascular anatomy, but the radicality of the treatment is insufficient. The aim of this study was to demonstrate the efficacy and safety of stent-assisted embolization of «acute» cerebral aneurysms. Material and methods. A retrospective analysis of the treatment of 234 patients with «acute» cerebral aneurysms was carried out. Results. Only coils were used in 40.6 % of cases (n = 95), balloon-assistance, in 40.2 % of cases (n = 94), and stent-assistance, in 19.2 % of cases (n = 45). There were 11.5 % (n = 27) clinically significant complications. Total aneurysm occlusion (Raymond-Roy I) was achieved in 187 cases (79.9 %); the radicality at the control examination was 67.1 % (157 patients). Discussion. The radicality of the treatment with stents was slightly higher then with balloons and coils at the end of operation (84.4 %, n = 38 and 78.8 %, n = 149, p > 0.05), but it was significantly higher at the control examination (80.0 %, n = 36 and 60.8 %, n = 115, respectively, p <0.05). Also, we had no statistically significant difference of the complication rate in the «stent» and «no stent» groups; therefore, the clinical outcomes of endovascular treatment of cerebral aneurysms did not depend on the choice of treatment method. Conclusions. Intracranial stents allow achieving good results of the embolization of complex aneurysms in the acute period of intracranial hemorrhage without increasing the risk of surgical treatment.

Keywords

• cerebral aneurysms
• acute rupture
• stent assistance