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Stability of Cerebral Aneurysms After Stent-Assisted Coil Embolization: A Propensity Score-Matched Analysis
Won-Sang Cho1, Hyun Sook Hong, Hyun-Seung Kang
1*Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea; ‡Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea; §Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Background:
The availability of stents has widened the indications of endovascular intervention for cerebral aneurysms.
Objective:
To elucidate the effect of stents on radiologic outcomes and to analyze the risk factors for aneurysmal recanalization via propensity score matching.
Methods:
From the 735 aneurysms treated with coil embolization with stents (n = 187) and without stents (n = 548) between 2009 and 2011, 157 propensity score-matched case pairs were selected. The recanalization rates and relevant risk factors were analyzed. The mean follow-up interval was 24.1 ± 11.3 months (range, 6-48 months) and 22.9 ± 11.4 months (range, 6-56 months) in the stent and nonstent groups, respectively (P = .388).
Results:
The stent group demonstrated lower recanalization rates than the nonstent group during both the 6-month (1.9% vs 10.2%, P = .004) and the final follow-up periods (8.3% vs 18.5%, P = .005). The multivariate analysis identified the following significant factors for recanalization: the use of stents (hazard ratio, 0.40; 95% confidence interval, 0.21-0.76, P = .005), larger aneurysm size (hazard ratio, 1.21; 95% confidence interval, 1.11-1.31, P < .001), and initially incomplete occlusion (hazard ratio, 2.39; 95% confidence interval, 1.28-4.43, P = .006). The incidence of permanent neurological complication tended to be higher in the stent group than in the nonstent group (3.2% vs 0%, P = .063).
Conclusion:
In this propensity score-matched analysis, stent implantation reduced the overall recanalization of the coiled cerebral aneurysms. However, the use of stents should be carefully decided upon.
