Stent-assisted coiling of cerebrovascular aneurysms: experience at a large tertiary care center with a focus on predictors of recurrence.

Abstract

Stent-assisted coiling is commonly used to treat wide-necked and fusiform cerebral aneurysms. We evaluated our institutional experience with stent-assisted coiling of cerebral aneurysms to elucidate potential risk factors for recurrence. A retrospective analysis of patients undergoing stent-assisted coiling of cerebral aneurysms from 2005 to 2012 resulted in 122 patients with 122 aneurysms. Demographic, peri-procedural, medical comorbidity, and follow-up data were collected. Primary outcomes of interest were procedural safety, efficacy, and aneurysm recurrence. Univariate and multivariate logistic regression and χ² tests determined the statistical significance of the risk factors. All 122 stent-assisted coiling procedures led to satisfactory obliteration of the aneurysm (3.3% complication rate). Twenty-one (17.2%) patients experienced recurrence at average follow-up of 297 days. Fifteen (71.4%) clinically significant recurrences required retreatment. Eleven of 30 (36.7%) procedures using Enterprise stents had recurrence compared with only 10 of 92 (10.9%) procedures using Neuroform stents (p=0.001). Average coiling packing density (PD) was 20.3% with Enterprise stents and 22.5% with Neuroform stents (p=0.8). In multivariate logistic regression, recurrences requiring recoiling were significantly associated with Enterprise stents (OR 8.57, 95% CI 1.97 to 37.19; p=0.004), females (OR 0.19, 95% CI 0.04 to 1.00; p=0.05), and postoperative dextran use (OR 8.42, 95% CI 1.40 to 50.58; p=0.02). Aneurysms with <20% PD were more likely to have a clinically significant recurrence than aneurysms with >20% PD (19% vs 5.1%; p=0.02). Stent-assisted coiling for wide-necked cerebral aneurysms has a high therapeutic success rate with low procedure-related morbidity and mortality. Clinically significant recurrences may occur more frequently with Enterprise stents, in aneurysms with low PD, and with post-procedural dextran use.