Response to Letter by van Rooij et al
There was a misunderstanding concerning the rates of complication in our series. The overall procedure-related complication rate within the group of 216 stented aneurysms was 7.4% (16/216). Among these 16 complications, 10 led to the patient deaths (10/216; 4.6%). Consequently, 7.4% (and not 12%, as stated by our colleagues1 in their comments) of the patients had permanent neurological deficit or died as a direct consequence of the treatment.
We remind the readers that our series included cases treated from 2002 (the first cases with balloon-expandable stents) up to 2009. During this period, stent technology evolved dramatically, allowing us to diminish our rate of complications, specifically thrombotic complications. It would have been easier for us not to include the cases treated with first-generation stents (balloon-expandable and Leo stent; see Table 3), which were responsible for increased complication rates in view of current devices, but it appeared to us more truthful to depict our entire history of stent-assisted coiling.
The decrease of angiographic recurrence with stents is clearly and significantly demonstrated in our series. Flow diversion attributable to the stent is one of the hypotheses to explain the improved stability of aneurysm occlusion over time. Creating a scaffold across the neck of the aneurysm for endothelial colonization is also one of the hypotheses.