Stent-Assisted Coiling vs. Flow Diversion in Unruptured Anterior Circulation Aneurysms: A Single-Center Cohort Study

Area of Science:

• Endovascular neurosurgery
• Cerebrovascular disease
• Medical device technology

Background:

• Stent-assisted coiling (SAC) and flow diversion (FD) are endovascular techniques for treating brain aneurysms.
• SAC achieves immediate occlusion, while FD promotes gradual vessel remodeling.
• Comparative data for unruptured anterior circulation aneurysms are limited.

Purpose of the Study:

• To compare the efficacy and safety of SAC versus FD for unruptured anterior circulation aneurysms.
• To evaluate outcomes including occlusion rates, retreatment needs, complications, and functional status.

Main Methods:

• Retrospective review of 129 aneurysms treated with SAC (n=33) or FD (n=96) between 2021-2024.
• 1:1 propensity score matching (PSM) was used to control for patient and aneurysm characteristics.
• Outcomes assessed: angiographic occlusion, retreatment, complications, and modified Rankin Scale (mRS).

Main Results:

• SAC achieved higher immediate occlusion (60% vs. 10% in matched cohort), while FD showed superior long-term stability.
• No retreatments were needed for FD, compared to 15% for SAC in the matched cohort.
• Complication rates were comparable, but single-stent SAC had a safety profile similar to FD, unlike complex multi-stent reconstructions.

Conclusions:

• SAC provides rapid occlusion but necessitates higher retreatment rates.
• FD ensures durable occlusion with no need for retreatment and a consistent safety profile.
• Treatment choice should be tailored, considering aneurysm complexity and patient factors, with a strategy of "Close fast with SAC, close forever with FD."