A prospective single-center analysis of the safety and efficacy of the HydroCoil embolization system for the treatment of intracranial aneurysms

2007 ◽  
Vol 106 (2) ◽  
pp. 226-233 ◽  
Author(s):  
Eric M. Deshaies ◽  
Matthew A. Adamo ◽  
Alan S. Boulos
Keyword(s):  
Recurrence Rate ◽  
Neurological Complication ◽  
Contrast Material ◽  
Senior Author ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Aneurysm Embolization ◽  
Cranial Nerve Palsies ◽  
Bare Platinum Coils

Object The HydroCoil embolization system is a helical platinum coil coated with a polymeric hydrogel that expands when it contacts aqueous solutions to increase filling volumes, improve mesh stability, and possibly elicit a healing response within the aneurysm. In this paper, the authors report the 1-year recurrence and complication rates of 67 aneurysms embolized with the HydroCoil system. Methods Sixty-four consecutive patients (67 total aneurysms) with small (≤ 7 mm), large (8–15 mm), very large (16–24 mm), and giant (≥ 25 mm) aneurysms in the anterior and posterior intracranial circulations were treated with HydroCoils between March 2003 and September 2004. All aneurysms were embolized by the senior author (A.S.B) with HydroCoils alone or in combination with bare platinum coils, until either there was no further angiographic contrast filling of the aneurysm or the microcatheter was pushed out of the dome by the coil mass. Balloon assistance was used in three cases and combined Neuroform stent–coil embolization in eight other cases. To evaluate the safety and 1-year efficacy of the HydroCoil system, periprocedural complications were recorded, and angiographic recurrences were categorized using the Raymond–Roy Occlusion Classification (RROC) system. The 1-year aneurysm recurrence rate independent of size was 15% in patients treated with HydroCoils. Seventy percent of the patients had stable occlusions. The recurrence rate for small aneurysms was 3.7%, and the combined recurrence rate for small and large aneurysms was 6%. Fifteen percent of the aneurysms initially categorized as RROC Type 2 or 3 with stasis of contrast material at the time of initial embolization improved in RROC type, allowing the authors to develop the aneurysm embolization grade to predict recurrence. The neurological complication rate was 14.9%, of which 4.5% represented permanent neurological deficits. Conclusions The HydroCoil embolization system is safe and provides excellent 1-year occlusion of small and large aneurysms with initial RROC Type 1, as well as those with RROC Types 2 and 3 with stasis of contrast material at the time of embolization. Very large and giant aneurysms were not as successfully occluded with this system. Treatment of large and giant internal carotid artery aneurysms was more likely to result in cranial nerve palsies and postembolization headaches than treatment in other locations. The aneurysm embolization grade the authors developed using the results of this study accurately predicted 1-year recurrence rates based on the immediate postembolization angiographic characteristics of the treated aneurysm.

SURGERY FOR CONVEXITY MENINGIOMAS

Neurosurgery ◽  
2008 ◽  
Vol 63 (3) ◽  
pp. 427-434 ◽  
Author(s):  
Andrew P. Morokoff ◽  
Jacob Zauberman ◽  
Peter M. Black
Keyword(s):  
Recurrence Rate ◽  
Malignant Tumors ◽  
Surgical Techniques ◽  
Senior Author ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Complete Excision ◽  
Image Guided

ABSTRACT OBJECTIVE Meningiomas that occur over the convexity of the brain are the most common meningiomas, but little has been published about their contemporary management. We aimed to analyze a large series of convexity meningiomas with respect to surgical technique, complication rates, and pathological factors leading to recurrence. METHODS We retrospectively reviewed 163 cases of convexity meningiomas operated on in our institution by the senior author (PMB) between 1986 and 2005. The median follow-up time was 2.3 years (range, 1–13 yr). RESULTS Convexity tumors represented 22% of all meningiomas operated on. There was a female:male ratio of 2.7:1. Median age was 57 years (range, 20–89 yr). Image-guided surgery was used on all cases in the last 5 years. The 30-day mortality rate was 0%. The incidence of new neurological deficits was 1.7%, and the overall complication rate was 9.4%. The pathology of the tumors was benign in 144 (88.3%), atypical in 16 (9.8%), and anaplastic/malignant in 3 (1.8%). In six of the cases designated “benign,” there were borderline atypical features. The 5-year recurrence rate for benign meningiomas was 1.8%, atypical meningiomas 27.2%, and anaplastic meningiomas 50%. The two cases of benign tumor recurrences involved tumors with borderline atypia and high MIB-1 indices. The borderline atypical cases had a 5-year recurrence-free survival rate of only 55.9%, more closely approximating that of tumors designated “atypical.” CONCLUSION Convexity meningiomas can be safely removed using modern image-guided minimally invasive surgical techniques with a very low operative mortality. Benign convexity meningiomas having a Simpson Grade I complete excision have a very low recurrence rate. The recurrence rates of atypical and malignant tumors are significantly higher, and borderline atypical tumors should be considered to behave more like atypical rather than benign lesions. Longer-term follow-up data are needed to more accurately determine the recurrence rates of benign meningiomas.

Extent of resection of epidermoid tumors and risk of recurrence: case report and meta-analysis

2020 ◽  
Vol 133 (2) ◽  
pp. 291-301
Author(s):  
Brian M. Shear ◽  
Lan Jin ◽  
Yawei Zhang ◽  
Wyatt B. David ◽  
Elena I. Fomchenko ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Meta Analysis ◽  
Systemic Review ◽  
Benign Tumors ◽  
Recurrence Rates ◽  
Mixed Effect ◽  
Risk Of Recurrence ◽  
Epidermoid Tumor ◽  
Cranial Nerve Palsies

OBJECTIVEIntracranial epidermoid tumors are slow-growing, histologically benign tumors of epithelial cellular origin that can be symptomatic because of their size and mass effect. Neurosurgical resection, while the treatment of choice, can be quite challenging due to locations where these lesions commonly occur and their association with critical neurovascular structures. As such, subtotal resection (STR) rather than gross-total resection (GTR) can often be performed, rendering residual and recurrent tumor potentially problematic. The authors present a case of a 28-year-old man who underwent STR followed by aggressive repeat resection for regrowth, and they report the results of the largest meta-analysis to date of epidermoid tumors to compare recurrence rates for STR and GTR.METHODSThe authors conducted a systemic review of PubMed, Web of Science, and the Cochrane Collaboration following the PRISMA guidelines. They then conducted a proportional meta-analysis to compare the pooled recurrence rates between STR and GTR in the included studies. The authors developed fixed- and mixed-effect models to estimate the pooled proportions of recurrence among patients undergoing STR or GTR. They also investigated the relationship between recurrence rate and follow-up time in the previous studies using linear regression and natural cubic spline models.RESULTSOverall, 27 studies with 691 patients met the inclusion criteria; of these, 293 (42%) underwent STR and 398 (58%) received GTR. The average recurrence rate for all procedures was 11%. The proportional meta-analysis showed that the pooled recurrence rate after STR (21%) was 7 times greater than the rate after GTR (3%). The average recurrence rate for studies with longer follow-up durations (≥ 4.4 years) (17.4%) was significantly higher than the average recurrence rate for studies with shorter follow-up durations (< 4.4 years) (5.7%). The cutoff point of 4.4 years was selected based on the significant relationship between the recurrence rate of both STR and GTR and follow-up durations in the included studies (p = 0.008).CONCLUSIONSSTR is associated with a significantly higher rate of epidermoid tumor recurrence compared to GTR. Attempts at GTR should be made during the initial surgery with efforts to optimize success. Surgical expertise, as well as the use of adjuncts, such as intraoperative MRI and neuromonitoring, may increase the likelihood of completing a safe GTR and decreasing the long-term risk of recurrence. The most common surgical complications were transient cranial nerve palsies, occurring equally in STR and GTR cases when reported. In all postoperative epidermoid tumor cases, but particularly following STR, close follow-up with serial MRI, even years after surgery, is recommended.

scholarly journals Complication Profile Associated With S1 Pedicle Subtraction Osteotomy Compared to Other Spinal Levels

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Darryl Lau ◽  
Vedat Deviren ◽  
Christopher P Ames
Keyword(s):  
Complication Rate ◽  
Diastolic Heart Failure ◽  
Adult Spinal Deformity ◽  
Neurological Complication ◽  
Pedicle Subtraction Osteotomy ◽  
Senior Author ◽  
Complication Rates ◽  
Multicenter Studies ◽  
Complication Risk ◽  
Significant Difference

Abstract INTRODUCTION S1 pedicle subtraction osteotomy (PSO) is rarely indicated. Therefore, its complication profile is not well defined. This study compares complication rates following S1 PSO to PSO performed at other spinal levels. METHODS A retrospective study of a consecutive cohort of adult spinal deformity (ASD) patients who underwent thoracolumbar 3 column osteotomy (3CO) by the senior author from 2006 to 2018 was performed. Multivariate analysis was used to asses complication risk stratified by osteotomy level. RESULTS A total of 363 patients underwent 3CO: 54 lower thoracic, 305 lumbar, and 6 S1. The number of lumbar PSO by level are as fsollows: L1 (24), L2 (26), L3 (135), L4 (102), and L5 (16). The indications for S1 PSO in this series were: high grade spondylolisthesis (spondyloptosis) in 4 cases and sacral fracture in 2 cases. Overall complication rate was 27.5%. Surgical and neurologic complications occurred in 7.7% and 5.8% of cases, respectively. Complication rate by 3CO level are as follows: thoracic (31.5%), L1 (29.2%), L2 (34.6%), L3 (20.7%), L4 (32.4%), L5 (12.5%), and S1 (50.0%). Relative to the thoracic level, S1 PSO was independently associated higher complication with an increase odd ratio of 39.60 (CI 3.12-503.41, P = .005). For S1 PSO, surgical and neurological complication rate was 16.7% for both outcomes; there was no significant difference between the 3CO levels. Specific complications encountered was a case of atrial flutter causing diastolic heart failure, a case of anaphylactic transfusion reaction, and a case with L5 weakness requiring hematoma evacuation and reduction of correction. One patient (16.7%) required revision surgery secondary to pseudarthrosis. Mean follow-up was 35.7 mo. CONCLUSION S1 PSO is a formidable procedure and associated with significantly higher complication rates than PSO performed at other levels. However, the technique is feasible with experienced surgeons. Large multicenter studies are needed to investigate this further.

scholarly journals Endoscopic techniques to reduce recurrence rates after colorectal EMR: systematic review and meta-analysis

2021 ◽  
Author(s):  
Gijs Kemper ◽  
Ayla S. Turan ◽  
Erik J. Schoon ◽  
Ruud W. M. Schrauwen ◽  
Ludger S. M. Epping ◽  
...  
Keyword(s):  
Systematic Review ◽  
Recurrence Rate ◽  
Meta Analysis ◽  
Intervention Group ◽  
Secondary Outcome ◽  
High Recurrence Rate ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Soft Coagulation ◽  
Procedural Complication

Abstract Background Colorectal endoscopic mucosal resection (EMR) is an effective, safe, and minimally invasive treatment for large lateral spreading and sessile polyps. The reported high recurrence rate of approximately 20% is however one of the major drawbacks. Several endoscopic interventions have been suggested to reduce recurrence rates. We conducted a systematic review and meta-analysis to assess the efficacy of endoscopic interventions targeting the EMR margin to reduce recurrence rates. Methods We searched in PubMed and Ovid for studies comparing recurrence rates after interventions targeting the EMR margin with standard EMR. The primary outcome was the recurrence rate at the first surveillance colonoscopy (SC1) assessed histologically or macroscopically. For the meta-analysis, risk ratios (RRs) were calculated and pooled using a random effects model. The secondary outcome was post-procedural complication rates. Results Six studies with a total of 1335 lesions were included in the meta-analysis. The techniques performed in the intervention group targeting the resection margin were argon plasma coagulation, snare tip soft coagulation, extended EMR, and precutting EMR. The interventions reduced the adenoma recurrence rate with more than 50%, resulting in a pooled RR of 0.37 (95% CI 0.18, 0.76) comparing the intervention group with the control groups. Overall post-procedural complication rates did not increase significantly in the intervention arm (RR 1.30; 95% CI 0.65, 2.58). Conclusion Interventions targeting the EMR margin decrease recurrence rates and may not result in more complications.

Awake Craniotomy vs Surgery Under General Anesthesia for Resection of Supratentorial Lesions4

Neurosurgery ◽  
2011 ◽  
Vol 68 (5) ◽  
pp. 1192-1199 ◽  
Author(s):  
Oumar Sacko ◽  
Valérie Lauwers-Cances ◽  
David Brauge ◽  
Musa Sesay ◽  
Adam Brenner ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Brain Mapping ◽  
Neurological Outcome ◽  
Neurological Complication ◽  
Awake Craniotomy ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Eloquent Areas ◽  
Duration Of Surgery

Abstract BACKGROUND: The use of an awake craniotomy in the treatment of supratentorial lesions is a challenge for both patients and staff in the operation theater. OBJECT: To assess the safety and effectiveness of an awake craniotomy with brain mapping in comparison with a craniotomy performed under general anesthesia. METHODS: We prospectively compared 2 groups of patients who underwent surgery for supratentorial lesions: those in whom an awake craniotomy with intraoperative brain mapping was used (AC group, n = 214) and those in whom surgery was performed under general anesthesia (GA group, n = 361, including 72 patients with lesions in eloquent areas). The AC group included lesions in close proximity to the eloquent cortex that were surgically treated on an elective basis. RESULTS: Globally, the 2 groups were comparable in terms of sex, age, American Society of Anesthesiologists score, pathology, size of lesions, quality of resection, duration of surgery, and neurological outcome, and different in tumor location and preoperative neurological deficits (higher in the AC group). However, specific data analysis of patients with lesions in eloquent areas revealed a significantly better neurological outcome and quality of resection (P &lt; .001) in the AC group than the subgroup of GA patients with lesions in eloquent areas. Surgery was uneventful in AC patients and they were discharged home sooner. CONCLUSION: AC with brain mapping is safe and allows maximal removal of lesions close to functional areas with low neurological complication rates. It provides an excellent alternative to craniotomy under GA.

scholarly journals Complications in 622 Cases of Frame-Based Stereotactic Biopsy, a Decreasing Procedure

2008 ◽  
Vol 35 (1) ◽  
pp. 79-84 ◽  
Author(s):  
Paul N. Kongkham ◽  
Eva Knifed ◽  
Mandeep S. Tamber ◽  
Mark Bernstein
Keyword(s):  
Stereotactic Biopsy ◽  
Brain Biopsy ◽  
Senior Author ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Surgical Experience ◽  
Perioperative Mortality ◽  
Stereotactic Brain Biopsy ◽  
Histologic Diagnosis ◽  
Intracranial Lesions

Background:Frame-based stereotactic brain biopsy has played an important role in the management of patients with suspected neoplastic intracranial lesions over the last three decades. We reviewed the surgical experience of one surgeon to determine the nature and frequency of complications associated with this procedure.Methods:Records were reviewed for 858 patients undergoing frame-based stereotactic procedures from January 1986 to May 2006. Data on each case were prospectively collected by the senior author. Procedures for Ommaya reservoir placement, brachytherapy, stereotactic craniotomy flap localization, shunt placement, or treatment of previously-diagnosed intracranial cystic lesions were excluded, leaving 614 patients in whom a total of 622 procedures were performed for purely diagnostic purposes. Complication rates and their association with clinical variables were sought.Results:Morbidity and mortality rates were 6.9% (43/622) and 1.3% (8/622), respectively. The risk of symptomatic hemorrhage (intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH], intraventricular hemorrhage [IVH]) was 4.8%. The risks of transient or permanent neurological deficits were 2.9% (18/622) and 1.5% (9/622), respectively. Biopsy of deep-seated lesions was associated with increased overall complication rate, while biopsy of Glioblastoma Multiforme (GBM) was associated with perioperative mortality.Conclusions:Overall, complication rates were comparable with those in previous reports. The subgroup of patients with deep-seated lesions or a histologic diagnosis of GBM may possess an elevated risk of overall complications or mortality, respectively, compared to other patients undergoing frame-based stereotactic brain biopsy.

scholarly journals Classification and management of cervical paragangliomas

2011 ◽  
Vol 93 (8) ◽  
pp. 596-602 ◽  
Author(s):  
RJ Obholzer ◽  
R Hornigold ◽  
S Connor ◽  
MJ Gleeson
Keyword(s):  
Skull Base ◽  
Carotid Body ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Senior Author ◽  
Neurological Deficits ◽  
Extensive Experience ◽  
Lower Cranial Nerve ◽  
Transcervical Approach ◽  
Cranial Nerve Palsies

INTRODUCTION Cervical paragangliomas are slow-growing tumours that eventually cause lower cranial nerve palsies and infiltrate the skull base. Surgical treatment may cause the same deficits and, in some, risks more serious neurological deficits. We describe a classification used to guide investigation, consent and management of cervical paragangliomas based on extensive experience. METHODS The case notes of patients managed by the senior author at a tertiary referral skull base unit between 1987 and 2010 were reviewed retrospectively. A total of 87 cervical paragangliomas were identified in 70 patients (mean age: 46 years, range: 13–77 years). Of these, 35 patients had 36 vagal paragangliomas, 43 patients had 50 carotid body paragangliomas and 8 had both. One cervical paraganglioma arose from neither the carotid body nor the nodose ganglion. The main outcome measures were death, stroke, gastrostomy and tracheotomy. RESULTS All tumours were classified pre-operatively based on their relationship to the carotid artery, skull base and lower cranial nerves. Type 1 tumours were excised with a transcervical approach, type 2 with a transcervical-parotid approach and type 3 with a combined transcervical-parotid and infratemporal fossa approach. Type 4 patients underwent careful assessment and genetic counselling before any treatment was undertaken. There were no peri-operative deaths; two patients had strokes, one required a long-term feeding gastrostomy and none required a tracheotomy. CONCLUSIONS The use of a pre-operative classification system guides management and surgical approach, improves accuracy of consent, facilitates audit and clarifies which patients should be referred to specialised centres.

scholarly journals Parastomal Hernia: A Retrospective Nationwide Cohort Study Comparing Different Techniques with Long-Term Follow-Up

2021 ◽  
Author(s):  
Elisa Mäkäräinen-Uhlbäck ◽  
Jaana Vironen ◽  
Ville Falenius ◽  
Pia Nordström ◽  
Anu Välikoski ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hernia Repair ◽  
Recurrence Rate ◽  
Parastomal Hernia ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Parastomal Hernia Repair ◽  
Operation Rate ◽  
Repair Techniques

Abstract Background Parastomal hernia repair is a complex surgical procedure with high recurrence and complication rates. This retrospective nationwide cohort study presents the results of different parastomal hernia repair techniques in Finland. Methods All patients who underwent a primary end ostomy parastomal hernia repair in the nine participating hospitals during 2007–2017 were included in the study. The primary outcome measure was recurrence rate. Secondary outcomes were complications and re-operation rate. Results In total, 235 primary elective parastomal hernia repairs were performed in five university hospitals and four central hospitals in Finland during 2007–2017. The major techniques used were the Sugarbaker (38.8%), keyhole (16.3%), and sandwich techniques (15.4%). In addition, a specific intra-abdominal keyhole technique with a funnel-shaped mesh was utilized in 8.3% of the techniques; other parastomal hernia repair techniques were used in 21.3% of the cases. The median follow-up time was 39.0 months (0–146, SD 35.3). The recurrence rates after the keyhole, Sugarbaker, sandwich, specific funnel-shaped mesh, and other techniques were 35.9%, 21.5%, 13.5%, 15%, and 35.3%, respectively. The overall re-operation rate was 20.4%, while complications occurred in 26.3% of patients. Conclusion The recurrence rate after parastomal hernia repair is unacceptable in this nationwide cohort study. As PSH repair volumes are low, further multinational, randomized controlled trials and hernia registry data are needed to improve the results.

Abstract 112: Hydrocoils Reduce Recurrence Rates in Recently Ruptured Medium Sized Intracranial Aneurysms: A Subgroup Analysis of the HELPS Trial

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Waleed Brinjikji ◽  
Phil M White ◽  
Harry J Cloft ◽  
David F Kallmes
Keyword(s):  
Recurrence Rate ◽  
Subgroup Analysis ◽  
Controlled Trial ◽  
Multivariate Logistic Regression Analysis ◽  
Control Group ◽  
Recurrence Rates ◽  
Aneurysm Neck ◽  
Ruptured Aneurysms ◽  
Bare Platinum Coils ◽  
Platinum Coils

Background and Purpose: The Hydrocoil Endovascular aneurysm occlusion and Packing Study (HELPS) was a randomized controlled trial comparing Hydrocoil to bare platinum coils . We performed a subgroup analysis of angiographic and clinical outcomes of medium sized aneurysms in the HELPS trial. Methods: We selected all patients with medium sized aneurysms (5mm-9.9mm) in the HELPS trial. The following outcomes were compared between the HydroCoil and control groups: 1) any recurrence, 2) major recurrence, 3) retreatment and 4) good neurological outcome defined as mRS≤2. Outcomes of recently ruptured and non-recently ruptured aneurysms were compared separately. Comparisons between groups were performed using Fisher’s exact test. A multivariate logistic regression analysis adjusting for aneurysm neck size, shape, use of adjunctive device and rupture status was performed. Results: A total of 288 patients with medium sized aneurysms were randomized (144 in each group). At 15-18 months post-treatment, major recurrence rate was significantly lower in the HydroCoil group than the control group (18.6% versus 30.8%, P=0.03, respectively). For recently ruptured aneurysm patients, major recurrence rate was significantly lower for HydroCoil than controls (20.3% versus 47.5%, P=0.003), while rates were similar between coil types for unruptured aneurysms (16.7% versus 14.8%, P=0.80). On multivariate analysis for patients with recently ruptured aneurysms, HydroCoil was associated with lower odds of any recurrence as compared to bare platinum (OR=0.37, 95%CI=0.18-0.76, P=0.006) and major recurrence (OR=0.27, 95%CI=0.12-0.58, P=0.0007). There was a trend towards lower retreatment rates in the recently ruptured group treated with HydroCoil (OR=0.00, 95%CI=0.00-2.01, P=0.12). Conclusion: For recently ruptured, medium sized aneurysms, as compared to bare platinum coils HydroCoils were associated with lower rates of major recurrence that were both statistically significant and clinically relevant. These findings suggest that HydroCoils should be the preferred treatment for this subset of patients.

Comparison of Stent-Assisted Coiling vs Coiling Alone in 563 Intracranial Aneurysms

Neurosurgery ◽  
2015 ◽  
Vol 77 (2) ◽  
pp. 241-247 ◽  
Author(s):  
Hongchao Yang ◽  
Yong Sun ◽  
Yuhua Jiang ◽  
Xianli Lv ◽  
Yang Zhao ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Recurrence Rate ◽  
Intracranial Aneurysms ◽  
Endovascular Coiling ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Safety And Efficacy ◽  
Unruptured Aneurysms ◽  
Lower Recurrence Rate ◽  
Aneurysm Size

Abstract BACKGROUND: Stent-assisted coiling has been used in both unruptured and ruptured aneurysms, but the safety and efficacy still remain controversial. OBJECTIVE: To compare the safety and efficacy of stent-assisted coiling with coiling alone for intracranial aneurysms. METHODS: We retrospectively reviewed 512 patients treated by endovascular coiling or stent-assisted coiling over a 1-year period. The patients' clinical and imaging information was recorded. Procedure-related complication rates, recurrence rates, and clinical outcomes were analyzed in both the total aneurysms and the subgroups of ruptured and unruptured aneurysms. RESULTS: A total of 243 patients were treated by coiling alone and 269 patients were treated by stent-assisted coiling. Procedure-related complications occurred in 6.2% of patients in the coiling-alone group compared with 6.3% in the stent-assisted coiling group. The procedural permanent morbidity and mortality rates were 1.6% (4/243) and 1.2% (3/243), respectively, in the coiling-alone group and 1.1% (3/269) and 1.5% (4/269), respectively, in the stent-assisted coiling group. A significantly lower recurrence rate was found in the stent-assisted coiling group compared with the coiling-alone group (5.2% vs 16.5%, P = .002). In a comparison of subgroups of ruptured and unruptured aneurysms, the procedural complications rates were comparable in the 2 groups, with a lower recurrence rate in the stent-assisted coiling group. Multivariate analysis showed that larger aneurysm size and higher Hunt and Hess grade were predictors of procedural morbidity; larger aneurysm size, ruptured aneurysm, anterior circulation aneurysms, initial incomplete occlusion, and lack of stent assistance were predictors of recurrence. CONCLUSION: Compared with coiling alone, stent-assisted coiling may achieve lower recurrence rates, with comparable procedure-related complications and clinical outcomes in both ruptured and unruptured aneurysms.

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