Stent-Assisted Coiling Versus Balloon-Assisted Coiling for the Treatment of Ruptured Wide-Necked Aneurysms: A 2-Center Experience

Background: Balloon-assisted coiling (BAC) and stent-assisted coiling (SAC) have been established as feasible approaches to manage ruptured wide-necked intracranial aneurysms. Antiplatelet medications used with SAC theoretically increase risk of thrombotic and hemorrhagic complications. This study aims to evaluate safety and efficacy of SAC versus BAC for acutely ruptured wide-necked intracranial aneurysms. Methods: We performed a 2-center retrospective observational study of consecutive patients treated with SAC or BAC for ruptured wide-necked intracranial aneurysms from 2015 to 2020. Baseline demographics, comorbidities, and aneurysm characteristics were collected. Primary and secondary efficacy outcomes were radiographic aneurysm occlusion at follow-up and functional status at 3 months. Safety outcomes included periprocedural hemorrhagic/ischemic complications and symptomatic ventriculostomy tract and cerebrospinal shunt hemorrhage rates. Univariable and multivariable analyses with multiple imputations to account for follow-up loss were performed. Results: A total of 112 and 109 patients underwent SAC and BAC, respectively. Median cohort age was 56 years, and 72% were female. Baseline characteristics were similar. Hydrocephalus rate was higher in the SAC group (78% versus 64%; P=0.02). Median aneurysm size was 5.1 mm. Anterior circulation aneurysms were most common (81%). Aneurysm and neck size were different, more aneurysms measuring <7 mm (80% versus 67%; P=0.02) and larger neck size aneurysms (3.7 versus 3.2 mm; P=0.02) were treated with SAC. At first follow-up, SAC showed higher rates of complete occlusion (61% versus 45%; P=0.02) before and after adjusting for confounders. Functional outcome was not different in the multivariable models after adjustment. Coil herniation was higher in the BAC group (8% versus 2%; P=0.03). Thromboembolic, hemorrhagic, and ventriculostomy complications were not different. The use of acute antithrombotic therapy was not associated with symptomatic ventriculostomy tract hemorrhage. Conclusion: Our findings suggest that SAC may be as safe as BAC for the acute management of ruptured wide-necked intracranial aneurysms without significant risk of ischemic and hemorrhagic complications.