Comparative Safety And Efficacy Of Stent-assisted Endovascular Therapies Of Acute Intracranial Ruptured Aneurysm With Coiling Alone

ObjectiveSAH is a serious type of stroke caused by ruptured intracranial aneurysms.Endovascular treatment is an effective method to reduce the risk of rebleeding.The common methods of endovascular embolization are simple coil embolization and stentassisted embolization.with the renewal of the concept of blood flow guidance and vascular reconstruction,intracranial stent has become an important tool for the treatment of aneurysm.However,the safety and efficacy of stents are controversial for the treatment of ruptured aneurysm in the acute phase(≤ 28d).There are concerns that antiplatelet therapy after stent implantation will increase the risk of rebleeding.At present,the stent utilization rate of the major research centers for the treatment of ruptured aneurysm in the acute phase is getting higher and higher,and there is no consistent plan for the treatment of antiplatelet drugs in each center.In this study,we retrospectively analyze the data of patients with subarachnoid hemorrhage.According to the mode of treatment,the patients were divided into stent-assisted embolization group and simple embolization group.Through the statistical analysis of the incidence of bleeding events,ischemic events,mortality,disability rate and follow-up results of the two groups,the safety and efficacy of stent-assisted embolization of acute ruptured intracranial aneurysms were evaluated..MethodCollect the data of patients with ruptured aneurysms treated in our department from January 2011 to December 2017 and divide into stent assisted embolization group and simple embolization group.The stent-assisted embolization group was treated with antiplatelet therapy during or after operation,and the medication was adjusted according to the follow-up results,while the simple embolization group was not treated with antiplatelet therapy.Analyze the perioperative complications in the two groups including incidence of bleeding and ischemic events,the mortality rate.disability rate and the follow-up results with SPSS 21.0 software.Use Chi-square test and Fisher exect test,and consider that there is statistically significant when p< 0.05.Result1217 patients with SAH,aged 55.6 ±11.3 years,were enrolled in this study.there were 435 male patients(35.7%),782 female patients(64.3%),631 patients(51.8%)in stent-assisted embolization group and 586 patients(48.2%)in simple embolization group.Excluding the patients whose responsible aneurysm treated with different stents,The stent-assisted group included Enterprise stent(n = 233),LVIS stent(n = 198),Solitaire stent(n = 151),Neuroform stent(n = 27),Leo stent(n = 4)and Applo stent(n = 1).There were 58 cases of ischemic events(40 cases in stent-assisted group and 18 cases in simple embolization group),46 cases of bleeding events(16 cases in stentassisted group and 30 cases in simple embolization group),and 7 cases of disability(6 cases in stent-assisted group and 1 case in the simple embolization group),27 cases in the stent-assisted group(14 cases in the stent-assisted group and 13 cases in the simple embolization group).There was no significant difference in age,sex,hypertension,diabetes,aneurysm location,incidence of adverse events,mortality rate and disability rate between the two groups(p>0.05).The width of the aneurysm neck has significant difference,the neck of the aneurysms were wider in the stent-assisted treatment group.There was no significant difference in patients with Enterprise stents,LVIS stents and Solitaire stents in terms of adverse events and mortality rate and disability rate(p > 0.05).There were significant differences in the incidence of bleeding events(5.12% vs 2.53%),ischemic events(3.07% vs 6.34%),healing rate(53.9% vs 71.8%)and recurrence rate(25.5% vs 12.3%)between simple embolization and stent-assisted embolization(p < 0.05).The patients were analyzed according to the period of operation(group 1,January 2011 to December 2014;group 2,January 2015 to December 2017).There was no significant difference in the incidence of adverse events,bleeding,ischemia,death and disability in the same operation mode.There was a statistical difference in the incidence of bleeding events between group 1 and group 2 with simple embolization(p= 0.022 < 0.05)ConclusionFor endovascular treatment of acute ruptured aneurysms,stent-assisted coil embolization does not increase the incidence of adverse events,and reduces the recurrence of aneurysms,and does not increase the risk of death and disability,but the stent group had a poor outcome because of rebleeding.Stent-assisted embolization is relatively safe and effective in the treatment of patients with acute ruptured aneurysms.