Efficacy of stent implantation scheme on single stent-assisted coiling for the treatment of intracranial wide-necked bifurcation aneurysms
Objective To investigate the efficacy of stent implantation scheme in single stent-assisted coiling(SSAC)for the treatment of intracranial wide-necked bifurcation aneurysms(WNBA).Methods This retrospective analysis was performed on clinical data of 39 patients with unruptured WNBA admitted to the Department of Interventional Medicine of the First Affiliated Hospital of Zhengzhou University from April 2022 to May 2023.Twenty-two patients(SSAC group)were treated with SSAC based on the stent implantation scheme,of which side branches were selected to implant stents according to the principle of"distal side branch,large angular side branch,and large diameter side branch".Seventeen patients with WNBA who were treated with double stent-assisted coiling(DSAC)were enrolled in this study(defined as DSAC group).Patients in the two groups were compared on age,gender and the aneurysm location,aneurysm size,single aneurysm or multiple aneurysms,the number of daughter sac and Hunt-Hess scale(HHS)before operation as well as the ratio of in-stent thrombosis during the operation.The degree of aneurysm occlusion was evaluated based on the Raymond-Roy Occlusion Classification(RROC).The modified Rankin Scale(mRS)score was used to assess neurological function both at discharge and 3 to 6 months post operation.Furthermore,patients were reexamined on in-stent stenosis and RROC by imaging follow-up.Results There was no statistically significant difference between two groups on age,gender,aneurysm size,single aneurysm or multiple aneurysms,the number of daughter sac,or HHS before operation(all P＞0.05).The difference in aneurysm location between the two groups was statistically significant(P＜0.05).There was no statistically significant difference between SSAC group and DSAC group on the proportion of complete occlusion of the aneurysm,which were respectively 21/22 vs.17/17 immediately after operation and 12/15 vs.14/14 during follow-up period(both P＞0.05).However,patients in SSAC group had lower ratio in intraoperative stent thrombosis(3/22 vs.10/17)and in-stent stenosis during follow-up period(1/15 vs.7/14)than in DSAC group(both P＜0.05).The median of mRS both after operation and during follow-up period in SSAC group were lower than those in DSAC group(both 0 vs.2,both P＜0.05).Conclusion The application of stent implantation scheme in SSAC technique for the treatment of intracranial WNBA could lead to the same complete occlusion degree and better outcome as DSAC technique with few complications.
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