A comparative efficacy and safety study of Coiling – only and Stent-Assisted Coil Placement for the treatment of acute ruptured intracranial aneurysms

Postgraduate Thesis uoadl:2937663 101 Read counter

Unit:
Speciality Endovascular Techniques
Library of the School of Health Sciences
Deposit date:
2021-03-04
Year:
2021
Author:
Katseli Konstantina
Supervisors info:
Γερουλάκος Γεώργιος ,Καθηγητής,Ιατρική Σχολή ΕΚΠΑ,
Ιωάννης Κακίσης ,Καθηγητής,Ιατρική Σχολή ΕΚΠΑ,
Χατζηϊωάννου Αχιλλέας , Καθηγητής ,Ιατρική Σχολή ΕΚΠΑ,
Original Title:
Συγκριτική μελέτη ασφάλειας και αποτελεσματικότητας των εμβολισμών μόνο με σπειράματα και με σπειράματα υποβοηθούμενο με αυτοεκπτυσσόμενες ενδοπροθέσεις για την αντιμετώπιση των οξέος ραγέντων ενδοκράνιων ανευρυσμάτων
Languages:
Greek
Translated title:
A comparative efficacy and safety study of Coiling – only and Stent-Assisted Coil Placement for the treatment of acute ruptured intracranial aneurysms
Summary:
Objective: Safety and efficacy of stent-assisted coiling (SAC) versus coiling alone for the embolization of the acute ruptured intracranial aneurysms has not yet been verified. Endovascular coil embolization of acute ruptured aneurysms is widely accepted ; however, the principle limitation of this technique is the high aneurysm recurrence. On the other hand the stent – assisted coiling is a useful technique for wide neck aneurysms which efficiently prevents the recurrence for all types of aneurysms. The necessity of dual antiplatelet treatment is the main factor for this technique’s limitation for the embolization of acute ruptured aneurysms. The aim of this study is to compare the safety and efficacy of stent-assisted coiling and coiling-only techniques of embolization for the acute ruptured aneurysms in terms of : a) periprocedural and long term complications b) the angiographic and clinical outcome and c) the mortality .

Methods: We have reviewed data of 18 patients with 18 acute ruptured intracranial saccular aneurysms who have been treated with embolization within ten (10 ) days. Patients were divided into two groups : those treated with stent-assisted coiling (11 patients) and those treated with coiling alone (7 patients). Baseline characteristics, angiographic results ( immediate and long term ) , perioperative complications and mortality have been compared between the two groups.
The PubMed ,Google Scholar and NCBI platforms have been systematically searched for articles regarding safety and efficacy of stent-assisted coiling versus coiling only of acute ruptured intracranial aneurysms within 28 days since September 2000. The angiographic results, the clinical outcome and the baseline characteristics have been recorded.

Results: There were 6 observational studies involving 597 stent-assisted coiling and 1044 coiling- only patients. The pooled immediate occlusion rate for stent assisted coiling (SAC) was 57.1% ( range:45.6% -78.3%) and 61.9% ( range: 31.3% -88.9%) for coiling –only and in our study : SAC 28.6% and coiling –only 3 6.4% , with no significant differences between the two techniques. In angiographic follow up results, progressive thrombosis was more likely in stent assisted coiling compared to coil in the two studies : review SAC 79.8% (range : 50.9%-90.1%) , Coils 64.4% ( range: 40.3%-83.56%) ; our study SAC 100% and 75% με Coils. Aneurysm recurrence was considerably reduced in stent-assisted coiling : review SAC 4.8% ( range: 3.5% - 7.4%) ,Coils 19.6% ( range : 14.5%- 32.7%) - our study: SAC 0% and Coils 25%.
Concerning the periprocedural complications there was no significant difference between the two techniques : review SAC 9.3% - Coils 5.9% and our study: SAC 28.6% - Coils 36.4% . Finally, the difference in mortality between the two techniques, SAC and Coil-only, was insignificant : periprocedural mortality SAC 3.5% , review Coils 4% - our study : SAC 14.3% , Coils 18.2% and follow up mortality ; review : SAC 9.1% -Coils 10.6% -and our study : SAC 16.6% and Coils 22.2%.

Conclusions: Based on limited evidence, stent-assisted coiling compared to coiling only shows similar immediate and long term complication rates ,mortality rates, and lower aneurysms recurrence rates . According to this review and study, we deduce that stent assisted coiling is feasible and safe compared to coiling only for the embolization of acute ruptured intracranial aneurysms .
Main subject category:
Health Sciences
Keywords:
Intracranial ,SAC, Coils, Aneurysms, Efficiency, Ruptured, Stent, Acute
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
93
Number of pages:
62
File:
File access is restricted only to the intranet of UoA.

Συγκριτική μελέτη ασφάλειας και αποτελεσματικότητας των εμβολισμών μόνο με σπειράματα και με σπειράματα υποβοηθούμενο με αυτοεκ.pdf
1 MB
File access is restricted only to the intranet of UoA.