Multiple overlapping stent-assisted coiling improves efficacy and safety of treatment for complex intracranial aneurysms: a randomized trial

Abstract

Background Intracranial aneurysm rupture is the main cause of subarachnoid hemorrhage, leading to high disability and mortality. This study aimed to evaluate the clinical treatment effects of multiple overlapping stent-assisted coiling for complex intracranial aneurysms. Methods We conducted a randomized, controlled, single-blinded clinical trial among 168 patients diagnosed with complex intracranial aneurysms. Treatment allocation to either single stent (SS) group or multiple stent (MS) group was randomized at 1:1 ratio using a Web-based platform. The O’Kelly–Marotta (OKM) grading scale was used to evaluate the degree of aneurysm occlusion after operation and during follow-up. Good aneurysm occlusion was defined as OKM grade C–D. The modified Rankin Scale (mRS) was used to evaluate the neurological status and the clinical outcome of patients. Results Efficacy comparative analysis demonstrated that major recurrence of aneurysms was significantly reduced in the MS group ( P \u2009=\u20090.012). In addition, the MS group displayed significantly reduced number of patients with mRS between 3 and 6 ( P \u2009=\u20090.007) and increased number of patients with mRS between 0 and 1 ( P \u2009=\u20090.034). Furthermore, the MS group showed increased percentage of patients with OKM grade C–D ( P \u2009=\u20090.041). Compared with the SS group, the MS group exhibited decreased mortality ( P \u2009=\u20090.037) and morbidity ( P \u2009=\u20090.035). Conclusions Multiple overlapping stent-assisted coiling significantly improved the clinical treatment effects and provided a new method for complex intracranial aneurysms. Multiple overlapping stent-assisted coiling technique reduced the major recurrence of aneurysms compared with single stent. Multiple overlapping stent-assisted coiling improved neurological status of patients with aneurysms compared with single stent. Multiple stent-assisted coiling decreased the aneurysm occlusion after operation compared with single stent. Multiple overlapping stent-assisted coiling significantly improved the clinical treatment for complex intracranial aneurysms.