Safety and efficacy of stent-assisted coiling for acutely ruptured wide-necked intracranial aneurysms:comparison of LVIS stents with laser-cut stents

Background:To compare the safety and efficacy of LVIS stent-assisted coiling with those of laser-cut stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms.Methods:Patients with acutely ruptured wide-necked intracranial aneurysms treated with LVIS stent-assisted coiling(LVIS stent group)and laser-cut stent-assisted coiling(laser-cut stent group)were retrospectively reviewed from January 2014 to December 2017.Propensity score matching was used to adjust for potential differences in age,sex,aneurysm location,aneurysm size,neck width,Hunt-Hess grade,and modified Fisher grade.Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared.Univariate and multivariate analyses were performed to determine the associations between procedure-related complications and potential risk factors.Results:A total of 142 patients who underwent LVIS stent-assisted coiling and 93 patients who underwent laser-cut stent-assisted coiling were enrolled after 1:2 propensity score matching.The angiographic follow-up outcomes showed that the LVIS stent group had a slightly higher complete occlusion rate and lower recurrence rate than the laser-cut stent group(92.7%vs 80.6%;3.7%vs 9.7%,P=0.078).The clinical outcomes at discharge and follow-up between the two groups demonstrated no significant differences(P=0.495 and P=0.875,respectively).The rates of intraprocedural thrombosis,postprocedural thrombosis,postoperative early rebleeding,and procedure-related death were 0.7%(1/142),1.4%(2/142),2.8%(4/142),and 2.1%(3/142)in the LVIS stent group,respectively,and 4.3%(4/93),2.2%(2/93),1.1%(1/93),and 3.2%(3/93)in the laser-cut stent group,respectively(P=0.082,0.649,0.651,and 0.683).Nevertheless,the rates of overall procedure-related complications and intraprocedural rupture in the LVIS stent group were significantly lower than those in the laser-cut stent group(5.6%vs 14.0%,P=0.028;0.7%vs 6.5%,P=0.016).Multivariate analysis showed that laser-cut stent-assisted coiling was an independent predictor for overall procedurerelated complications(OR=2.727,P=0.037);a history of diabetes(OR=7.275,P=0.027)and other cerebrovascular diseases(OR=8.083,P=0.022)were independent predictors for ischemic complications,whereas none of the factors were predictors for hemorrhagic complications.Conclusions:Compared with laser-cut stent-assisted coiling,LVIS stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms could reduce the rates of overall procedure-related complications and intraprocedural rupture.