Stent-assisted Coil Placement For The Treatment Of Wide-necked Saccular Aneurysms:Analysis Of Outcome And Procedure-related Complications

Purpose:To evaluate the safety, the angiographic and the clinical outcome of patients with wide-necked saccular aneurysms treated by stent-assisted coil placement (SACP) in a single center during an eight-year period. The outcome and the procedure-related complications were analyzed to figure out the related risk factors.Methods:The clinical and imagining data of the patients with wide-necked saccular aneurysms treated by coiling in Department of Neurosurgery, Nanjing General Hospital of Nanjing Military Command, from March 2008 to December 2015 was analyzed retrospectively. The patients included were all treated by SACP for the first time. The following information was collected, including gender, age, previous history (hypertension, diabetes, smoking history), Hunt-Hess grade at admission, size of aneurysm, stent placement strategy, procedure-related complications, immediate embolization degree, and MRS at discharge. Pearson x2 or Fisher exact test was performed for categorical variables, to determine the association of unfavorable outcome and procedure-related complications with potential related risk factors. Multiple logistic regression analysis was performed to determine the independent association of unfavorable outcome and procedure-related complications with these factors.Results:In this study,360 cases were chosen by the including criteria and exclusion criteria. Clinical outcome was good in 335 patients (93.06%) with a modified Rankin Scale score 0-2. For all the patients with ruptured aneurysm,85.03% of them could get good clinical outcome. For patients with ruptured intracranial wide-necked saccular artery aneurysms, age (p=0.041), Hunt-Hess grade at admission(p<0.001) were significantly influence factors of outcome. Higher Hunt-Hess grade (p<0.001, OR 28.79) and large aneurysm (p=0.019, OR 0.149) were independent factors for bad outcome. Of all the 360 cases, procedure-related complications were associated with whether the aneurysms ruptured or not and the difference was obvious (p<0.001). Procedure-related complications occurred in 22 patients (14.96%) of all the 147 cases with ruptured aneurysm, which was obviously higher than patients with unruptured aneurysms (5.44%) (p< 0.001). For patients with unruptured aneurysms, age, gender, history of hypertension and diabetes, smoking history, the size of aneurysm, Raymond grade after surgery all had no influences. In 147 cases of ruptured aneurysm patients,2.04% of them could suffer bleeding before or during the surgery. The incidence of thrombotic events was 15.6%. The overall incidence of complications could be satisfied. For patients with ruptured intracranial wide-necked saccular aneurysms, location (p=0.002) and size (p=0.028) were risk factors for complications. Large aneurysm(34.78%) and middle cerebral artery aneurysm may cause higher rates of Procedure-related complications.Conclusion:SACP is safe and effective for the treatment of intracranial wide-necked saccular artery aneurysms. The incidence of overall clinical outcomes and complications can be satisfied. For patients with unruptured aneurysm, we did not find the risk factors that could affect outcome and complications. For patients with ruptured aneurysms, elderly people (>65 years) and higher Hunt-Hess grade on admission, a large aneurysm may all indicate poor prognosis probability; Large aneurysm is an independent risk factors for procedure-related complications.