Ruptured Wide-Necked Aneurysms: Is Stent-Assisted Coiling During Posthemorrhage Days 4-10 Safe and Efficient?

Recent studies have reported the use of stent-assisted coiling (SAC) for wide-necked aneurysms in patients with acute subarachnoid hemorrhage (SAH). This study attempted to determine whether it is safe and efficient to use SAC for wide-necked aneurysms during post-SAH days 4-10.

We reviewed 126 consecutive patients with ruptured wide-necked aneurysms who underwent SAC. The patients were classified into the early cohort (SAC was performed within post-SAH days 0-3) and late cohort (SAC was performed within post-SAH days 4-10). Intergroup differences in patients' demographics, aneurysm features, angiographic vasospasm, periprocedural complications, and clinical and angiographic outcomes were analyzed.

Of the 126 study patients, there were 70 (55.6%) in the early cohort and 56 (44.4%) in the late cohort. Angiographic vasospasm was significantly more likely to occur in patients treated in the late cohort (P < 0.05). No difference (P > 0.05) in age, sex, hypertension, dichotomized Fisher grade, dichotomized Hunt-Hess score, aneurysm features, aneurysm location, or periprocedural complications was found between the cohorts. We followed up 112 patients, in whom clinical and angiographic results showed no statistical significance (P > 0.05) between the 2 cohorts. When the patients were divided based on the dichotomized modified Rankin Scale into the "good outcome" and "poor outcome" groups at 6 months follow-up, higher Hunt-Hess scores (P < 0.001) were the only independent risk factors for poor outcome on multivariate logistic regression analysis.

Patients with ruptured wide-necked aneurysms treated on posthemorrhage days 4-10 did not appear to have worse outcomes compared to patients treated on posthemorrhage days 0-3.