Stent-Assisted Coiling for Wide-Neck Ruptured Cerebral Aneurysms: An Observational Survey of Data from the Japanese Registry of Neuroendovascular Therapy 4.

Abstract

The safety and efficacy of stent-assisted coiling (SAC) in ruptured cerebral aneurysms remain controversial. The aim of this study was to assess the feasibility of using SAC for the treatment of ruptured wide-neck aneurysms in Japan. We retrospectively analyzed data from the Japanese Registry of Neuroendovascular Therapy 4 from 2015 to 2019. Data on intra-aneurysmal embolization for ruptured wide-neck aneurysms within 14 days of subarachnoid hemorrhage onset were extracted. The incidence of favorable clinical outcomes at 30 days, hemorrhagic complications within 24 hours, aneurysmal rebleeding, and thromboembolic events (TEs) were compared between the SAC and non-SAC groups. A subgroup analysis was performed to clarify the risk factors for intraprocedural TEs in patients after SAC. In the univariate analysis of 3083 procedures, no significant difference in the rate of favorable clinical outcomes was noted between the SAC and non-SAC groups (p=0.303). No significant differences in the rates of hemorrhagic complications within 24 h (p=0.396) and aneurysmal rebleeding (p=0.793) were found between the 2 groups, whereas the TE rate was significantly higher in the SAC group than in the non-SAC group (13.0% vs. 8.5%, p=0.004). The subgroup analysis revealed that non preoperative initiation of dual antiplatelet therapy was an independent predictor of intraprocedural TEs in SAC (adjusted odds ratio: 2.39, 95% confidence interval: 1.11-5.47, p=0.026). The 30-day clinical outcomes were comparable between both groups, suggesting the feasibility of SAC for ruptured cerebral aneurysms. Preoperative antiplatelet therapy is an important factor for overcoming TEs.