Study: Stenting during endo coiling can thwart aneurysm recurrence

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Aneurysm recurrence is a major concern during endovascular coiling procedures, however, inserting a stent in patients undergoing aneurysm repair with endovascular coiling reduced the recurrence rate of aneurysms by almost 25 percent, researchers found in a study published in the July issue of the Journal of Neurointerventional Surgery.

The rate of aneurysm recurrence during endovascular coiling is greater than 30 percent. In comparison, traditional aneurysm surgery has a recurrence rate of about 2 percent. “The adjunct use of self-expandable stents has revolutionized the treatment of intracranial aneurysms, especially for complex morphologies, wide necks or unfavorable dome to neck ratios,” Geoffrey P. Colby, MD, from the department of neurosurgery at Johns Hopkins Hospital in Baltimore, and colleagues wrote. “However, further investigation into the durability and outcomes of stent assisted coiling procedures is required.”

The researchers assessed the records of 90 patients with paraophthalmic aneurysms who underwent coil embolization procedures at Johns Hopkins between May 1992 and March 2009. Thirty of the patients received a stent.

Colby and colleagues noted that complete aneurysm occlusion was obtained on the initial angiography for 43.3 percent and 31.7 percent of stented and non-stented patients, respectively. After follow-up, aneurysm recurrence occurred in 11.5 percent of stented patients compared with 35.9 percent of the non-stented patients.

After the study's longest follow-up period (14.5 months for stented patients and 37.6 months for non-stented patients), aneurysm recurrence occurred in 15.4 percent of stented patients and 41.5 percent of non-stented patients. Yet, the authors noted that there was no significant correlation between aneurysm recurrence and aneurysm size or coiling.

"It's easy to treat someone's aneurysm, but can you treat it durably and make it last? We've now shown in our study that stenting — something that makes sense from an engineering perspective, a clinical perspective and a common sense perspective — truly works," the study's senior author Alexander Coon, MD, director of endovascular surgery at Johns Hopkins, concluded.