Laser-cut stent-assisted coil embolization for basilar apex aneurysms: a retrospective single-center study

To describe procedural and early outcomes following laser-cut Stent-Assisted Coil Embolization (SACE) for Basilar Apex Aneurysms (BAAs) at a single institution.

The authors conducted a retrospective review of 43 consecutive patients with BAAs (both ruptured and unruptured) who underwent laser-cut SACE between September 2019 and April 2023. Outcomes included procedural success (defined as successful stent deployment and coil embolization without procedural abandonment or device malfunction), immediate and 6-month angiographic occlusion status (Raymond classification), periprocedural complications, and 3-month clinical status (modified Rankin Scale, mRS). Treatment strategies (single-stent vs. Y-configuration) and stent types (Enterprise vs. Atlas) were selected per operator discretion.

The procedural success rate was 100%. Immediate post-procedural angiography showed complete occlusion (Raymond I) in 81.4% (35/43) and neck remnant (Raymond II) in 18.6% (8/43). The periprocedural complication rate was 9.3% (4/43), including two thromboembolic events (4.7%), one fatal brain herniation, and one other non-specified complication. Among 42 surviving patients, 88.1% (37/42) had an mRS score ≤ 2 at 3-months. Six-month angiographic follow-up, available for 37 patients (86.0%), revealed complete occlusion in 97.3% (36/37) and neck remnant in 2.7% (1/37). Subgroup analyses comparing single-stent (n = 38) and Y-stent (n = 5) techniques, as well as Enterprise (n = 21) and Atlas (n = 17) stents in single-SACE, showed no statistically significant differences in occlusion rates or clinical outcomes, though these analyses were underpowered.

In this single-center, retrospective experience of patients with saccular BAAs, laser-cut SACE for BAAs was associated with high procedural success and favorable early angiographic and clinical outcomes.