Comparative Analysis Of Stent-assisted Coil Embolization And Simple Coil Embolization In The Treatment Of Intracranial Ruptured Aneurysms

Objective:To investigate the efficacy and safety of stent-assisted coil embolization versus simple coil embolization in the treatment of intracranial ruptured aneurysms,and to analyze the related factors of aneurysm occlusion status and clinical outcomes during follow-up.Methods:A total of 171 patients with acute ruptured aneurysm who received stent-assisted coil or coil-only embolization from March 2016 to March 2021 in the Department of Neurosurgery of the First Hospital of Shanxi Medical University were retrospectively analyzed and followed up.By observing and comparing the information of the two groups of patients,including age,gender,living habits,underlying diseases,preoperative HuntHess classification,aneurysm location,aneurysm size and length of hospital stay and other baseline characteristics,perioperative complications,the clinical outcome(modified Rankin Scale(MRS)score)at 6-month follow-up,the degree of tumor filling density(Raymond grade)and the changes of angiography were rechecked immediately and 6months after operation,and statistical analysis was carried out.Results:The 171 patients were divided into two groups,of which 110(64.3%)received stentassisted embolization(stent group)and 61(35.7%)received coil-only(bare-coil group)embolization.Both groups had similar baseline characteristics.No statistical difference.There were 14 cases(12.7%)and 2 cases(3.3%)of acute thrombotic events in the stent group and the bare ring group,respectively,P=0.042.In the 6-month DSA angiography results,there were 103 cases(93.6%)and 58 cases(78.7%)of complete occlusion in the stent group and 58 cases(78.7%)in the bare ring group,and 7 cases(6.4%)and 13 cases(21.3%)of incomplete occlusion,respectively),P=0.004.In the angiographic changes,2 cases(1.8%)and 7 cases(11.5%)in the stent group and the bare ring group were recanalized,respectively,P=0.011;the stent group and the bare ring group were further occludedwere 15(13.7%)and 2(4.9%),respectively,P=0.030.The final aneurysm occlusion status was associated with stent placement(P=0.004)and the degree of aneurysm embolization immediately after surgery(P<0.001).The final clinical outcome was related to age(P=0.015),the preoperative Hunt-Hess classification(P=0.004)and the occurrence of perioperative adverse events(P<0.001),but not to the treatment method.There were no significant differences between the two groups in other perioperative complications and immediate embolization outcomes.Conclusion:In the vascular interventional treatment of intracranial ruptured aneurysms,compared with simple coil embolization,stent-assisted embolization is safe,and can further occlude the aneurysm and reduce the recurrence rate of the long-term aneurysm,and the overall occlusion rate is better.The final aneurysm occlusion status is not only related to stent placement,but also to the degree of immediate postoperative embolization.Final clinical outcomes were related to age,preoperative Hunt-Hess class,and perioperative adverse events.