Balloon remodeling may improve angiographic results of stent-assisted coiling of unruptured intracranial aneurysms.

Gentric, Jean-Christophe; Biondi, Alessandra; Piotin, Michel; Mounayer, Charbel; Lobotesis, Kyriakos; Bonafé, Alain; Costalat, Vincent

BACKGROUND Endovascular treatment of wide-necked and complex aneurysms may require stent-assisted coiling, either as primary stenting or combined with the balloon remodeling technique (BRT). OBJECTIVE To compare the angiographic results and clinical outcomes of both strategies in the Safety and Efficacy of Neuroform for Treatment of intracranial Aneurysms (SENAT) registry. METHODS SENAT was a prospective, multicenter registry that allowed BRT in conjunction with stenting and coiling with bare platinum coils. Clinical and angiographic outcomes of 97 patients with unruptured aneurysms treated with stenting, 51 after BRT (BRT+) and 46 without balloon assistance (BRT-), were retrieved from the SENAT database. Technical, clinical, and angiographic outcomes were compared between the 2 groups. RESULTS Periprocedural morbimortality and midterm clinical outcomes were not different between groups. Residual aneurysms were observed in 7.8% of BRT+ and in 21.7% of BRT- (P = .08) at the end of the stenting procedure. Four retreatments were performed during the follow-up period (2 BRT+, 2 BRT-). Twelve- to 18-month anatomic results showed a significant difference between groups, with a residual aneurysm being observed in 6.1% of BRT+ as compared to 22.7% of BRT- patients (P = .03). CONCLUSION Primary BRT followed by stent-assisted coiling may be associated with fewer residual aneurysms at 12 to 18 months as compared to stent-assisted coiling alone.