Single Stage versus Multi-staged Stent-assisted Endovascular Repair of Intracranial Aneurysms

Abstract

Background: Stent-assisted coiling of intracranial aneurysms is performed either as a singlestage or a multi-staged procedure. The objective of ourstudy isto compare the complications
between the in single-stage versus the multi-staged stent-assisted coiling of intracranial
aneurysm.
Methods: From January 2003 to January 2010, consecutive patients treated with intracranial
stent for aneurysms were prospectively enrolled. Patients’ demographics including
cerebrovascular risk factors, aneurysms size and locations were collected. Technical and
clinical complications aswell asoutcomesweremeasured.Datawere analyzedretrospectively
using SPSS software version 11.5.
Results: 87 patients (87 aneurysms) with a mean of 51.2 ± 13.6 years were treated with 90
intracranial (Neuroform 74, Enterprise 16) stents, single-stage 37 (42.5%) and multi-staged
50 (57.5%). Eight adverse events were observed without any mortality, 6 of which were in
the single-stage group-rupture of aneurysm in 2, and thrombo-embolic events in 4. Both
rupture occurred in basilar artery bifurcation aneurysms, required ventriculostomy and
resuscitations. In single-stage, asymptomatic intra-operative stent thrombosis developed
in one, symptomatic stent thrombosis in one on day 14, transient ischemic attack on day 6
and immediate post operative stroke in one. Only two minor strokes were observed in the
multi-staged group, one on post-procedure day 7 and other on day 60. Majority of the patients had good outcomesincluding those with
events.
Conclusion: Our study revealed that single-stage stent-coiling technique is associated with a higher rate of complications than multistaged procedure. Therefore, staging the procedure may be an option whenever possible