Treatment Of Acutely Ruptured Wide-necked Intracranial Aneurysms Using Self-expanding Stent

Objective:Comparing the effectiveness of endovascular treatment for patients with ruptured intracranial wide-necked aneurysms before or after 72h (the acute phase) and retrospective analyze the embolization rate, follow-up and prognosis of both treatment. Summarize the experience on using self-expending stents in interventional technique, in order to reduce the incidence of aneurysm broken again and the related complications.Methods:From Jan.2009 to May,2014, one hundred and fifty-eight consecutive patients with ruptured intracranial aneurysms underwent endovascular treatment at the First Hospital of Hebei Medical University. Seventy-six patients were treated within 72 hours and 82 cases of interventional treatment in the non-acute phase (> 72 hours). Both of the two groups were treated with intracranial self-expanding stent-assisted technology (SCAT). Grade of occlusion, angiographic follow-up and clinical outcome at the end of the procedure were evaluated using statistic method.Results:1 Curative effect:Group in acute stage:Stents were all released in place in 76 patients. Immediately postoperative CT scans shows that,34 cases (44%) were completely obliterated,38 residual necked ((50%) and 4 (5.3%) not 100% occluded. Clinical outcome was evaluated at discharge,60 patients (78.9%) had no symptoms,4 (5.3%) revealed neurological deficits,10 (32%) were in coma and 2 cases (2.6%) died in hospital. Nine stents-related complications occurred in 76 cases:1 patient was intra-operative bleeding,2 cases were incomplete Broca Aphasia,2 case of hemorrhage after operative and 2 thrombus being come into being at the place where stents were implanted. (One case in coma and the other had the right-side hemiparalysis and mixture aphasia resulting from Watershed infraction). A total of 20 cases of patients accepted imaging follow-up, average follow-up time of 3.7+/-0.82 months (3 to 5 months), including tumor residual neck in 2 cases (10%),18 cases (90%) complete embolization.Group in non-acute stage:All of the 82 patients were taken with stents-assisted coiling embolism technique. Immediate postoperative CT scans suggested that,46 cases (56.1%) were completely embolized,34 (41.5%) necked-remained and 2 (2.4%) partially embolization. Clinical outcome was evaluated at discharge,72 patients (87.8%) had no symptoms,8 (5.3%) revealed neurological deficits and 2 (2.4%) were still unawake. Four stents-related complications took place in 82 cases:2 cases were incomplete Broca Aphasia,1 was postoperative rebreeding,1 thrombus-formed nearby the stent, which was recanalization after actively thrombolytic therapy. None was intra-operative hemorrhage. A total of 30 patients had received about 3 to 6 months angiographic follow-up, of which mean period was 4.73 months, ranging from -1.16 to +1.16 months.4 (13.3%) cases were neck remained,26 (86.7%) completely occluded and no recrudescence or occurred.2 Comparing the two groups in their complete embolism rate immediately after the treatment,44.7% in acute stage completely 100% occluded immediately after the operation, while the non-acute one was 56.1%. There was no significant difference between the two groups in complete embolism rate.(x2=2.04,P>0.05)。3 Comparing the two groups in the follow-up rate of the 100% occluded, it turns out that stent assisted coiling technique increased the embolism ratio which the acute was 90% and the other was 86.7%. However, we could still see the clear distinction between them.4 Comparing the two groups in outcome effectiveness on different timing undergone with stents-assisted coiling endovascular treatment at their discharge, the rate of poor-outcome was 15.8% in the acute group and 2.4% in the non-acute group. It showed obvious discrepancy between the two groups in complete embolism rate (χ22=8.71, P<0.01). The rate in the acute group is much higher than the one in the non-acute.Conclusions:1 It is very effective and useful to treat acutely ruptured intracranial aneurysms with stent assisted coiling interventional technique in 72 hours.2 The risk of stent-assisted coiling technique remains in acute stage is dramatically higher than that in the non-acute phase.3 Need to further study the long-term stability of the acute stent-assisted coiling technique and the incidence of stent thrombosis embolism and bleeding risk.