Staged Stenting with or without Additional Coils after Conventional Initial Coiling of Acute Ruptured Wide-Neck Intracranial Aneurysms.

Background: Stent-assisted coiling technique has been more and more adopted in the treatment of intracranial aneurysms and has been shown to improve long-term angiographic results; however, the treatment is relatively contraindicated in acutely ruptured aneurysms for its ischemic and hemorrhagic complications. Staged stenting after conventional coiling has emerged as a potential treatment strategy for ruptured wide-neck aneurysms. This study assessed the safety and efficacy of coiling in the acute phase followed by delayed stenting for ruptured wide-neck intracranial aneurysms.

Methods: Patients with ruptured wide-neck intracranial saccular aneurysms treated with endovascular coiling in acute phase followed by stent placement at a later date (4 weeks) in our center between November 2006 and September 2016 were reviewed. The primary outcomes were procedural safety, target aneurysm rebleeding, and long-term follow-up of clinical and angiographic outcomes.

Results: A total of 47 patients were enrolled in this study, all patients received staged therapy of stent placement at the required time. The median interval time to retreatment was 4.2 weeks. No cases of rebleeding occurred during the intervals between coiling and stent implantation. No permanent morbidity or mortality resulting from stenting or coiling was observed. All 47 patients underwent angiographic follow-up at a mean of 16.1 months, and complete occlusion was achieved in 38 (80.85%) patients. A total of 44 patients had modified Rankin Scale scores ≤2 during a mean of 21 months.

Conclusions: Staged treatment of ruptured wide-neck aneurysms with coiling in the acute phase followed by delayed stenting is safe and effective.