Single Stage versus Multi-staged Stent-assisted Endovascular Repair of Intracranial Aneurysms

Stent-assisted coiling of intracranial aneurysms is performed either as a single-stage or a multi-staged procedure. The objective of our study is to compare the complications between the in single-stage versus the multi-staged stent-assisted coiling of intracranial aneurysm.

From January 2003 to January 2010, consecutive patients treated with intracranial stent for aneurysms were prospectively enrolled. Patients' demographics including cerebrovascular risk factors, aneurysms size and locations were collected. Technical and clinical complications as well as outcomes were measured. Data were analyzed retrospectively using SPSS software version 11.5.

87 patients (87 aneurysms) with a mean of 51.2 ± 13.6 years were treated with 90 intracranial (Neuroform 74, Enterprise 16) stents, single-stage 37 (42.5%) and multi-staged 50 (57.5%). Eight adverse events were observed without any mortality, 6 of which were in the single-stage group-rupture of aneurysm in 2, and thrombo-embolic events in 4. Both rupture occurred in basilar artery bifurcation aneurysms, required ventriculostomy and resuscitations. In single-stage, asymptomatic intra-operative stent thrombosis developed in one, symptomatic stent thrombosis in one on day 14, transient ischemic attack on day 6 and immediate post operative stroke in one. Only two minor strokes were observed in the multi-staged group, one on post-procedure day 7 and other on day 60. Majority of the patients had good outcomes including those with events.

Our study revealed that single-stage stent-coiling technique is associated with a higher rate of complications than multistaged procedure. Therefore, staging the procedure may be an option whenever possible.