Stent-Assisted Coil Embolization for Ruptured Wide-Neck Aneurysms in the Acute Phase of Subarachnoid Hemorrhage: A...

Stent-assisted coil embolization (SAC) has expanded the treatment options for ruptured wide-neck aneurysms; however, SAC during the acute phase of subarachnoid hemorrhage (SAH) remains controversial owing to concerns regarding thromboembolic and hemorrhagic complications. This study aimed to evaluate the feasibility and safety of SAC for ruptured wide-neck aneurysms in the acute phase of SAH at a single center in Japan.

Patients with ruptured wide-neck aneurysms who underwent endovascular treatment within 48 h after SAH onset between January 2015 and December 2024 were retrospectively evaluated. Wide-neck aneurysms were defined as those with a neck width of ≥4 mm or a dome-to-neck ratio of <2. Patients were divided into 2 groups: the SAC group and the non-SAC group. The primary outcome was perioperative complications. Secondary outcomes included angiographic outcomes, clinical outcomes at discharge and 1-year follow-up, and retreatment rates.

A total of 140 patients were included (SAC group, n = 24; non-SAC group, n = 116). Aneurysms in the SAC group demonstrated more complex morphology, particularly lower aneurysm height and smaller dome-to-neck ratios. The rates of perioperative hemorrhagic complications (12.5% vs. 9.4%) and symptomatic thromboembolic complications (8.3% vs. 8.6%) were comparable between the SAC and non-SAC groups. The immediate angiographic outcomes did not differ significantly between the 2 groups. Clinical outcomes at discharge and at 1-year follow-up did not differ significantly.

SAC for ruptured wide-neck aneurysms in the acute phase of SAH appears to be feasible with no significant differences in perioperative complication rates or clinical outcomes compared with non-SAC treatment. With appropriate patient selection and careful antiplatelet management, SAC may be a reasonable treatment option.