Background: In the endovascular treatment of wide-necked unruptured aneurysms, there is controversy over which adjunctive device (stent vs. balloon) is appropriate. At the payer level it has been posited that stents and balloons treat the same aneurysms, and as such the more expensive stents should not be reimbursed.
Objective: We challenge this assertion, and instead hypothesize that aneurysms treated with stent assistance are morphologically different than those selected for balloon assistance.
Methods: Retrospective review of unruptured aneurysms treated with an adjunctive device between 2008-2010. Morphological analysis was performed on the pretreatment 2-D catheter angiogram. The immediate post-treatment Raymond score was compared to that seen on the 12-month follow-up angiogram.
Results: 106 unruptured aneurysms were treated with an adjunctive device and followed for a mean of 24.5 months. Morphological analysis revealed a lower dome-to-neck ratio (1.5 vs. 1.2) and aspect ratio (1.44 vs. 1.16) in the aneurysms treated with stent assistance vs. balloon assistance. Of the 15.3% that were worse on follow-up angiography, there was no statistical difference between those treated with a stent vs. a balloon (17.1% vs. 14.2%). The overall retreatment rate was 10.2% and was not statistically different between the 2 groups (12.7% vs. 5.7%).
Conclusion: We found that unruptured aneurysms selected for treatment with stent-assisted coiling are morphologically different from those selected for treatment with balloon assistance. Despite the more challenging morphology, Raymond scores and retreatment rates at 1 year were not statistically different between the 2 groups, suggesting an important role for stents in the treatment of unruptured aneurysms.
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