Stent-assisted coiling in ruptured wide-necked aneurysms: A single-center analysis

BACKGROUND: To evaluate the safety and efficacy of stent-assisted coiling of ruptured intracranial wide-necked aneurysms in a setting of acute subarachnoid hemorrhage, without compromising on the antiplatelet regimen. METHODS: Forty-two consecutive patients who underwent stent-assisted coiling for ruptured wide-necked intracranial aneurysms from August 2008 to May 2012 were studied. Demographic data like age, sex, Hunt & Hess grade, Fischer scale, and location, and size of the aneurysms were noted. Complications such as aneurysmal rupture, bleeding complications, thromboembolic events, etc. were documented. Also, 30-day and 1-year outcome was measured using modified Rankin scale (mRS). RESULTS: Forty-four wide-necked aneurysms were treated in 42 patients with stent-assisted coiling from August 2008 to May 2012 in our institution, out of a total of 248 aneurysms treated endovascularly in the same period. All these patients presented with subarachnoid hemorrhage (SAH) with varying grades and were treated in the acute phase, i.e. within 1 week of the ictus. There were 24 males and 18 females in the age group ranging from 12 to 78 years, with a mean of 45 years. Technical success was achieved in 39 patients with complete angiographic cure (93%). Intraprocedural stent thrombosis was seen in two patients, which resolved with intra-arterial bolus of tirofiban, and both the patients did not have any neurological deficit. Rebleed occurred in two patients of which one patient succumbed. Six patients required external ventricular drain because of worsening hydrocephalus on computed tomography (CT) scan with clinical deterioration. There was one death in our series due to rebleed. Three other patients died in a period of 1 month due to complications not related to the coiling procedure which include vasospasm, pulmonary embolism, and respiratory infection. All the patients were clinically followed up at 1 month, 3 months, 6 months, and 1 year. Also, angiographic follow- up was done at 1 year in 25 patients (72%). All the patients were maintained on clopidogrel 75 mg per day and ecospirin 150 mg per day for a period of 1 year and were advised to continue ecospirin 150 mg per day lifelong. CONCLUSION: Even in a setting of acute SAH, stent-assisted coiling can be an effective and safe treatment option with acceptable risks in experienced hands.