Recent advances in stent-assisted coiling of cerebral aneurysms

ABSTRACT

Introduction

Stent-assisted coiling (SAC) of intracranial aneurysms paved the way for endovascular coiling of wide-neck and bifurcation aneurysms, improving rates of aneurysm obliteration and recurrence. In this review, we provide a comprehensive review of the most recent advances related to stent-assisted coiling of intracranial aneurysm.

Areas covered

The authors have made an attempt to cover the inception, applications, and limitations of SAC of intracranial aneurysms. Special focus is given to 1) the current and recently introduced SAC techniques, 2) most recent advances in device technology, and 3) outcome data for the discussed techniques and devices. The authors also discuss the potential future direction of SAC.

Expert opinion

technical refinements in the field of SAC should continue to focus on device development and addressing the limitations of SAC, namely aneurysm recurrence and need of antiplatelet agents. Although the recurrence rate of SAC has not been shown to be inferior to flow diverters, the use of intrasaccular and intravascular flow diverters are likely to expand in the future at the expense of SAC.

KEYWORDS:

• Aneurysms
• cerebral
• coiling
• endovascular
• stent-assisted

Article highlights

• Stent-assisted coiling (SAC) techniques were developed for wide-neck and bifurcations intracranial aneurysms, significantly expanding the spectrum of aneurysms treatable by endovascular methods.

• SAC is associated with increased thromboembolic complications and hemorrhagic events, associated with the use of antiplatelet agents, which is particularly relevant to the treatment of ruptured aneurysms.

• Several assist devices, including temporary neck-bridging devices discussed here, have been introduced recently to address the relatively high rate of aneurysm recanalization and the need for dual antiplatelet agents associated with SAC.

Although randomized control trials comparing stent-assisted coiling and flow diversion are not available yet, intravascular and intrasaccular flow diversion are likely to play a dominant role in the future of endovascular treatment of aneurysms.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.