Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance

A review of 235 cases

Nohra Chalouhi, Pascal Jabbour, L. Fernando Gonzalez, Aaron S. Dumont, Robert Rosenwasser, Robert M. Starke, David Gordon, Shannon Hann, Stavropoula Tjoumakaris

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

BACKGROUND: Endovascular therapy is now the preferred treatment option for basilar tip aneurysms (BTAs). OBJECTIVE: To compare the safety and efficacy of common endovascular techniques in the treatment of BTAs. METHODS: A retrospective review was conducted of 235 patients with BTAs treated with endovascular means in our institution between 2004 and 2011. Categorization was based on the presence and type of stent assistance (none, single, and Y stenting). The rates of perioperative complications, recanalization, rehemorrhage, and retreatment were analyzed. RESULTS: A total of 147 patients were treated with coil embolization and 88 patients with stent-assisted coiling (72 single stents, 16 Y stents). Thromboembolic complications occurred in 6.8% of patients in both groups. There was no associated mortality. Angiographic follow-up (mean, 23.5 months) was available in 172 patients (77.1%). Stented patients had significantly lower recanalization (17.2% vs 38.9%; P =.003) and retreatment (7.8% vs 27.8%; P =.002) rates compared with nonstented patients. Four rehemorrhages (2.7%) occurred in the coiled group, whereas none were noted in the stented group (P =.3). In paired comparisons, lower recanalization (8.3% vs 19.2%; P =.21) and retreatment (0% vs 9.6%; P =.19) rates were seen in the Y-stent group compared with the single-stent group. Thromboembolic complications occurred in 6.9% and 6.2% of patients in the single-stent and Y-stent groups, respectively (P =.91). In multivariate analysis, larger aneurysms, nonstented aneurysms, incomplete initial occlusion, and subarachnoid hemorrhage were predictors of aneurysm recanalization. CONCLUSION: Stent-assisted coiling has significantly lower recurrence, retreatment, and rehemorrhage rates than coiling alone for the treatment of BTAs. Y stenting has the highest efficacy with low complication rates.

Original languageEnglish (US)
Pages (from-to)785-794
Number of pages10
JournalNeurosurgery
Volume71
Issue number4
DOIs
StatePublished - Oct 2012
Externally publishedYes

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Stents
Aneurysm
Safety
Retreatment
Matched-Pair Analysis
Endovascular Procedures
Subarachnoid Hemorrhage
Therapeutics
Multivariate Analysis
Recurrence
Mortality

Keywords

  • Aneurysms
  • Basilar tip
  • Coils
  • Endovascular
  • Stent

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Chalouhi, N., Jabbour, P., Gonzalez, L. F., Dumont, A. S., Rosenwasser, R., Starke, R. M., ... Tjoumakaris, S. (2012). Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance: A review of 235 cases. Neurosurgery, 71(4), 785-794. https://doi.org/10.1227/NEU.0b013e318265a416

Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance : A review of 235 cases. / Chalouhi, Nohra; Jabbour, Pascal; Gonzalez, L. Fernando; Dumont, Aaron S.; Rosenwasser, Robert; Starke, Robert M.; Gordon, David; Hann, Shannon; Tjoumakaris, Stavropoula.

In: Neurosurgery, Vol. 71, No. 4, 10.2012, p. 785-794.

Research output: Contribution to journalArticle

Chalouhi, N, Jabbour, P, Gonzalez, LF, Dumont, AS, Rosenwasser, R, Starke, RM, Gordon, D, Hann, S & Tjoumakaris, S 2012, 'Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance: A review of 235 cases', Neurosurgery, vol. 71, no. 4, pp. 785-794. https://doi.org/10.1227/NEU.0b013e318265a416
Chalouhi, Nohra ; Jabbour, Pascal ; Gonzalez, L. Fernando ; Dumont, Aaron S. ; Rosenwasser, Robert ; Starke, Robert M. ; Gordon, David ; Hann, Shannon ; Tjoumakaris, Stavropoula. / Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance : A review of 235 cases. In: Neurosurgery. 2012 ; Vol. 71, No. 4. pp. 785-794.
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abstract = "BACKGROUND: Endovascular therapy is now the preferred treatment option for basilar tip aneurysms (BTAs). OBJECTIVE: To compare the safety and efficacy of common endovascular techniques in the treatment of BTAs. METHODS: A retrospective review was conducted of 235 patients with BTAs treated with endovascular means in our institution between 2004 and 2011. Categorization was based on the presence and type of stent assistance (none, single, and Y stenting). The rates of perioperative complications, recanalization, rehemorrhage, and retreatment were analyzed. RESULTS: A total of 147 patients were treated with coil embolization and 88 patients with stent-assisted coiling (72 single stents, 16 Y stents). Thromboembolic complications occurred in 6.8{\%} of patients in both groups. There was no associated mortality. Angiographic follow-up (mean, 23.5 months) was available in 172 patients (77.1{\%}). Stented patients had significantly lower recanalization (17.2{\%} vs 38.9{\%}; P =.003) and retreatment (7.8{\%} vs 27.8{\%}; P =.002) rates compared with nonstented patients. Four rehemorrhages (2.7{\%}) occurred in the coiled group, whereas none were noted in the stented group (P =.3). In paired comparisons, lower recanalization (8.3{\%} vs 19.2{\%}; P =.21) and retreatment (0{\%} vs 9.6{\%}; P =.19) rates were seen in the Y-stent group compared with the single-stent group. Thromboembolic complications occurred in 6.9{\%} and 6.2{\%} of patients in the single-stent and Y-stent groups, respectively (P =.91). In multivariate analysis, larger aneurysms, nonstented aneurysms, incomplete initial occlusion, and subarachnoid hemorrhage were predictors of aneurysm recanalization. CONCLUSION: Stent-assisted coiling has significantly lower recurrence, retreatment, and rehemorrhage rates than coiling alone for the treatment of BTAs. Y stenting has the highest efficacy with low complication rates.",
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AU - Gonzalez, L. Fernando

AU - Dumont, Aaron S.

AU - Rosenwasser, Robert

AU - Starke, Robert M.

AU - Gordon, David

AU - Hann, Shannon

AU - Tjoumakaris, Stavropoula

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N2 - BACKGROUND: Endovascular therapy is now the preferred treatment option for basilar tip aneurysms (BTAs). OBJECTIVE: To compare the safety and efficacy of common endovascular techniques in the treatment of BTAs. METHODS: A retrospective review was conducted of 235 patients with BTAs treated with endovascular means in our institution between 2004 and 2011. Categorization was based on the presence and type of stent assistance (none, single, and Y stenting). The rates of perioperative complications, recanalization, rehemorrhage, and retreatment were analyzed. RESULTS: A total of 147 patients were treated with coil embolization and 88 patients with stent-assisted coiling (72 single stents, 16 Y stents). Thromboembolic complications occurred in 6.8% of patients in both groups. There was no associated mortality. Angiographic follow-up (mean, 23.5 months) was available in 172 patients (77.1%). Stented patients had significantly lower recanalization (17.2% vs 38.9%; P =.003) and retreatment (7.8% vs 27.8%; P =.002) rates compared with nonstented patients. Four rehemorrhages (2.7%) occurred in the coiled group, whereas none were noted in the stented group (P =.3). In paired comparisons, lower recanalization (8.3% vs 19.2%; P =.21) and retreatment (0% vs 9.6%; P =.19) rates were seen in the Y-stent group compared with the single-stent group. Thromboembolic complications occurred in 6.9% and 6.2% of patients in the single-stent and Y-stent groups, respectively (P =.91). In multivariate analysis, larger aneurysms, nonstented aneurysms, incomplete initial occlusion, and subarachnoid hemorrhage were predictors of aneurysm recanalization. CONCLUSION: Stent-assisted coiling has significantly lower recurrence, retreatment, and rehemorrhage rates than coiling alone for the treatment of BTAs. Y stenting has the highest efficacy with low complication rates.

AB - BACKGROUND: Endovascular therapy is now the preferred treatment option for basilar tip aneurysms (BTAs). OBJECTIVE: To compare the safety and efficacy of common endovascular techniques in the treatment of BTAs. METHODS: A retrospective review was conducted of 235 patients with BTAs treated with endovascular means in our institution between 2004 and 2011. Categorization was based on the presence and type of stent assistance (none, single, and Y stenting). The rates of perioperative complications, recanalization, rehemorrhage, and retreatment were analyzed. RESULTS: A total of 147 patients were treated with coil embolization and 88 patients with stent-assisted coiling (72 single stents, 16 Y stents). Thromboembolic complications occurred in 6.8% of patients in both groups. There was no associated mortality. Angiographic follow-up (mean, 23.5 months) was available in 172 patients (77.1%). Stented patients had significantly lower recanalization (17.2% vs 38.9%; P =.003) and retreatment (7.8% vs 27.8%; P =.002) rates compared with nonstented patients. Four rehemorrhages (2.7%) occurred in the coiled group, whereas none were noted in the stented group (P =.3). In paired comparisons, lower recanalization (8.3% vs 19.2%; P =.21) and retreatment (0% vs 9.6%; P =.19) rates were seen in the Y-stent group compared with the single-stent group. Thromboembolic complications occurred in 6.9% and 6.2% of patients in the single-stent and Y-stent groups, respectively (P =.91). In multivariate analysis, larger aneurysms, nonstented aneurysms, incomplete initial occlusion, and subarachnoid hemorrhage were predictors of aneurysm recanalization. CONCLUSION: Stent-assisted coiling has significantly lower recurrence, retreatment, and rehemorrhage rates than coiling alone for the treatment of BTAs. Y stenting has the highest efficacy with low complication rates.

KW - Aneurysms

KW - Basilar tip

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