Staged vs stent-assisted coiling vs coiling alone: Safety and efficacy in acute ruptured wide-necked intracranial...

This study aims to thoroughly analyze and compare the clinical efficacy and safety of three methods for treating acute ruptured wide-necked intracranial aneurysms: stent-assisted coiling (SAC), coiling alone (CA), and staged stent-assisted coiling (s-SAC). By comprehensively evaluating the therapeutic outcomes, recovery times, and potential complications associated with these methods, the research seeks to provide clinicians with a rationale for optimizing treatment strategies, thereby enhancing the therapeutic outcomes and safety for patients with acute ruptured wide-necked intracranial aneurysms.

We carried out a review of patients who experienced acute ruptures of wide-necked intracranial aneurysms and were treated with SAC, CA, or s-SAC between September 2014 and December 2019. Using a 1:1:1 propensity score matching method, the study involved 59 patients treated with CA, 62 with standard SAC, and 62 who had s-SAC procedures. The analysis compared baseline features, procedural complications, clinical outcomes, and angiographic findings among the three groups.

Among the three groups, there was a statistically significant difference in the rate of hemorrhagic complications (P = 0.018), with the s-SAC group showing a numerically lower rate of hemorrhage. The overall incidence of perioperative complications in the s-SAC group (4.8 %) was not statistically different from that in the CA (1.7 %) and SAC (9.7 %) groups (P = 0.163). Additionally, the rates of immediate complete occlusion were lower in the CA and s-SAC groups (50.8 % and 25.8 %, respectively) compared to the conventional SAC group (72.6 %). However, no significant outcome differences emerged at follow-up (P = 0.357).

During the treatment of acute ruptured wide-necked intracranial aneurysms, we found that the application of s-SAC appeared to represent a viable, safe, and potentially effective strategy. This approach could provide a favorable balance between minimizing complications and maintaining aneurysmal occlusion rates, thereby positively influencing patient outcomes in this complex clinical context.