A Study Of Clinical And Angiographic Outcomes With Short-Term Results Following Stent-Assisted Endovascular Treatment Of Intracranial Aneurysms In 549 Cases

Background and Purpose:At present,stent-assisted endovascular treatment has gradually become the first choice of complex intracranial aneurysms,including overlapped stenting.The purpose of this study is to assess the safety and efficacy of intracranial stenting and determine predictors of treatment outcomes.Methods:The clinical data and follow-up results of 549 patients with 604 intracranial aneurysms treated by endovascular treatment with different stents from January 2014 to December 2017 in our insititution were reviewed retrospectively.Patient and aneurysm characteristics,initial occlusion grades,perioperative complications were analyzed.The Glasgow outcome scale and Clavien-Dindo classification for complications were used to measure outcome when patients were discharged.Patients underwent angiographic follow-up at 1 month to 29 months after treatment.DSA images were analyzed to assess the recanalization rate of aneurysms and patency of the parent artery.A multivariate analysis was conducted to identify predictors of complications,recurrence and outcome.Besides,the safety and efficacy of overlapped stenting were evaluated in terms of initial occlusion grades,perioperative complications,clinical and angiographic outcome with short-term follow-up.Results:A total of 549 patients with intracranial aneurysms were treated with stent implantation with or without coiling,of which 229 patients(41.7%)presented SAH and 320 patients(58.3%)were treated electively with unruptured aneurysms.Complete occlusion was achieved in 84.3%of the aneurysms.Favorable outcomes were seen in 96.9%of elective patients and 91.3%in SAH patients.Complications occurred in 20%of patients,with 13 death or near death(2.4%).Ruptured aneurysm(OR=49.39;95%CI 12.9-187.2;P<0.001)?Raymond grade 2(OR=5.34;95%CI,1.46-15.54;P=0.01)and higher Hunt-Hess grade(OR=49.39;95%CI,12.9-187.2;<0.001)were the independent predictors of unfavorable outcome on logistic regression analysis.And ruptured aneurysms(OR=2.16;95%CI 1.24-3.75;P=0.006)?diabetes mellitus(OR=2.86;95%CI,1.33-6.14;P=0.007)?Hunt-Hess grade(OR=5.87;95%CI,1.87-18.39;P=0.002)were independent predictors of complications.Angiographic follow-up was available for 41.5%of patients at 6.8 months on average.Recanalization and in-stent stenosis rates were,respectively,7.8%and 3.5%.Larger aneurysm size(?10mm)predicted recurrence(OR=2.83;95%CI,1.00-7.96;P=0.049).And no statistically significant predictor was found for in-stent stenosis.There were 97 patients applied by overlapped stenting,with 3 patients(3.1%)of death or near death,all of which were ruptured aneurysms.2 patients(2.1%)died of massive cerebral infarction after operation and 1 patient(1.0%)died of the primary course(SAH).Clinical followed-up at 1-27 months(mean 6.7 months)was achieved in 83 patients.Favorable outcomes occurred in 98.8%of patients.Angiographic follow-up(mean duration 7.3 months)after overlapped stenting was carried out in 45 patients(46.4%):3(6.5%)had recanalization,3(6.5%)had in-stent stenosis.Conclusions:Stent-assisted coiling of intracranial aneurysms is safe,effective,and provides durable aneurysm closure at a short-term follow-up study.Severe complication is associated with treatment of ruptured aneurysms?higher Hunt-Hess grade?diabetes mellitus.Complete embolization reduces the risk of unfavourable outcome.Larger aneurysm size(?10mm)is associated with significantly recanalization rates.Compared with unruptured aneurysms,stent-assisted coiling of ruptured aneurysms did not increase the risk of intraoperative rupture,intraoperative thrombosis,postoperative intracranial hemorrhage,postoperative cerebral infarction,and postoperative TIA.Overlapped stenting made it possible for complex aneurysms to undergo endovascular treatment.It has a reasonable safety profile with good clinical outcomes.Overlapped stenting can't increase the risk of severe complications,recurrence,in-stent stenosis compared with conventional single stent-assited coiling.Besides,compared with Pipeline flow diversion,overlapped stenting has a lower incidence of intracranial hemorrhage and similar clinical and imaging outcomes.