Abstract 3768: Comparison Of Balloon Remodelled And Stent Assited Coil Embolization Of Cerebral Aneurysms.
Background: Both balloon remodeling and stent placement techniques are used for coil embolization of the large neck aneurysms. Comparison of safety and efficacy of these two endovascular approaches has not been reported in the past. We aimed to compare the risk of thromboembolic event (TEE), intra-operative rupture (IOP)and recanalization rates between the two techniques.
Methods: A review of a retrospectively collected database was performed, and all aneurysms treated with stent or balloon assistance between 07/2005 to 12/2010 were identified. Cases with a combined use of stent and balloon were excluded. Pearson Chi square 2x2 tables were used to calculate the odds ratio and p-value
Results: Among 791 aneurysms treated by endovascular cerebral aneurysm embolization (EAE), 81(10.3%) cases used balloon and 275 (35%) cases used stent assistance. Mean age and large neck (> 4 mm ) were not significantly different between the two groups. Balloon remodeling was used more commonly in ruptured aneurysm compare to stent-assistance ( 41% versus 15%; OR 3.7 CI 2.1-6.4; p value 0.0001). Both symptomatic and asymptomatic angiographically proven TEE occurred in 11 (14%) cases treated with a balloon and in 26 (9.5%) cases treated with stent-assistance (OR 1.5 CI 0.7-3.2; p-value 0.3). These TEEs were symptomatic in 2 (2.5%) cases treated with a balloon, and in 2 (0.7%) cases treated with stent-assistance. The rate of symptomatic and asymptomatic intraoperative rupture in balloon-remodeled cases was 1/81(1.2%) compare to 13/275 (4.7%) in stent-assisted cases (OR 4 CI 0.5-30). Symptomatic IOP occurred in 1/81(1.2%) and 1/275 (0.4%) case respectively (OR 3.4 CI 0.2-55). After excluding patient with lack of follow up imaging; 8/66 (12%) of balloon remodeled and 23/201(11.5%) of stent assisted cases had recanalization of the aneurysm defined as any filling of the sac or class 3 per Raymond classification. (OR 1.06 CI 0.4-2.5 p-value 0.8).
Conclusion: Balloon remodeling was more commonly used in ruptured aneurysm compared to stent assistance. No statistically significant difference was found in the risk of TEE, IOP or recanalization between the two techniques.
- © 2012 by American Heart Association, Inc.