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Are Aneurysms Treated With Balloon-Assisted Coiling and Stent-Assisted Coiling Different? Morphological Analysis of 113 Unruptured Wide-Necked Aneurysms Treated With Adjunctive Devices

Peterson, Eric MD, MS*; Hanak, Brian MD; Morton, Ryan MD; Osbun, Joshua W. MD; Levitt, Michael R. MD; Kim, Louis J. MD

Neurosurgery:
doi: 10.1227/NEU.0000000000000366
Research-Human-Clinical Studies
Abstract

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 and 2010. Morphological analysis was performed on the pretreatment 2-D catheter angiogram. The immediate posttreatment Raymond score was compared with that seen on the 12-month follow-up angiogram.

RESULTS: One hundred six 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 re-treatment 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 re-treatment rates at 1 year were not statistically different between the 2 groups, suggesting an important role for stents in the treatment of unruptured aneurysms.

ABBREVIATIONS: DSA, digital subtraction angiography

TE, thromboembolic

Author Information

*Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida;

Department of Neurological Surgery, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington

Correspondence: Louis J. Kim, MD, 325 9th Ave, Box 359924, Seattle WA 98104. E-mail: ljkim1@u.washington.edu

Received September 27, 2013

Accepted March 27, 2014

Copyright © by the Congress of Neurological Surgeons