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Research ArticleInterventional
Open Access

Stent-Assisted Coiling versus Coiling Alone in Unruptured Intracranial Aneurysms in the Matrix and Platinum Science Trial: Safety, Efficacy, and Mid-Term Outcomes

S.W. Hetts, A. Turk, J.D. English, C.F. Dowd, J. Mocco, C. Prestigiacomo, G. Nesbit, S.G. Ge, J.N. Jin, K. Carroll, Y. Murayama, A. Gholkar, S. Barnwell, D. Lopes, S.C. Johnston and C. McDougall on behalf of the Matrix and Platinum Science Trial Investigators
American Journal of Neuroradiology April 2014, 35 (4) 698-705; DOI: https://doi.org/10.3174/ajnr.A3755
S.W. Hetts
aFrom the Departments of Radiology and Biomedical Imaging (S.W.H., C.F.D.)
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A. Turk
cDepartment of Radiology (A.T.), Medical University of South Carolina, Charleston, South Carolina
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J.D. English
dDepartments of Neurology and Radiology (J.D.E.), California Pacific Medical Center, San Francisco, California
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C.F. Dowd
aFrom the Departments of Radiology and Biomedical Imaging (S.W.H., C.F.D.)
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J. Mocco
eDepartment of Neurosurgery (J.M.), Vanderbilt University Medical Center, Nashville, Tennessee
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C. Prestigiacomo
fDepartment of Neurosurgery (C.P.), University of Medicine and Dentistry of New Jersey, Newark, New Jersey
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G. Nesbit
gDepartment of Radiology (G.N., S.B.), Oregon Health and Science University, Portland, Oregon
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S.G. Ge
hDepartment of Biostatistics (S.G.G., J.N.J.)
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J.N. Jin
hDepartment of Biostatistics (S.G.G., J.N.J.)
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K. Carroll
iStryker Neurovascular (K.C.), Fremont, California
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Y. Murayama
jDepartment of Neurosurgery (Y.M.), Jikei University, Tokyo, Japan
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A. Gholkar
kDepartment of Neuroradiology (A.G.), Newcastle Upon Tyne Hospital, Newcastle Upon Tyne, United Kingdom
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S. Barnwell
gDepartment of Radiology (G.N., S.B.), Oregon Health and Science University, Portland, Oregon
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D. Lopes
lDepartment of Neurosurgery (D.L.), Rush University Medical Center, Chicago, Illinois
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S.C. Johnston
bNeurology (S.C.J.), University of California, San Francisco, San Francisco, California
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C. McDougall
mDepartment of Neurosurgery (C.M.), Barrow Neurological Institute, Phoenix, Arizona.
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Abstract

BACKGROUND AND PURPOSE: Stent-assisted coiling may result in less aneurysm recanalization but more complications than coiling alone. We evaluated outcomes of coiling with and without stents in the multicenter Matrix and Platinum Science Trial.

MATERIALS AND METHODS: All patients in the Matrix and Platinum Science Trial with unruptured intracranial aneurysms treated per protocol were included. Baseline patient and aneurysm characteristics, procedural details, neurologic outcomes, angiographic outcomes, and safety data were analyzed.

RESULTS: Overall, 137 of 361 (38%) patients were treated with a stent. Stent-coiled aneurysms had wider necks (≥4 mm in 62% with stents versus 33% without, P < .0001) and lower dome-to-neck ratios (1.3 versus 1.8, P < .0001). Periprocedural serious adverse events occurred infrequently in those treated with and without stents (6.6% versus 4.5%, P = .39). At 1 year, total significant adverse events, mortality, and worsening of mRS were similar in treatment groups, but ischemic strokes were more common in stent-coiled patients than in coiled patients (8.8% versus 2.2%, P = .005). However, multivariate analysis confirmed that at 2 years after treatment, prior cerebrovascular accident (OR, 4.7; P = .0089) and aneurysm neck width ≥4 mm (OR, 4.5; P = .02) were the only independent predictors of ischemic stroke. Stent use was not an independent predictor of ischemic stroke at 2 years (OR, 1.1; P = .94). Stent use did not predict target aneurysm recurrence at 2 years, but aneurysm dome size ≥10 mm (OR, 9.94; P < .0001) did predict target aneurysm recurrence.

CONCLUSIONS: Stent-coiling had similar outcomes as coiling despite stented aneurysms having more difficult morphology than coiled aneurysms. Increased ischemic events in stent-coiled aneurysms were attributable to baseline risk factors and aneurysm morphology.

ABBREVIATIONS:

MAPS
Matrix and Platinum Science Trial
TAR
target aneurysm recurrence
  • © 2014 by American Journal of Neuroradiology

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American Journal of Neuroradiology: 35 (4)
American Journal of Neuroradiology
Vol. 35, Issue 4
1 Apr 2014
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Stent-Assisted Coiling versus Coiling Alone in Unruptured Intracranial Aneurysms in the Matrix and Platinum Science Trial: Safety, Efficacy, and Mid-Term Outcomes
S.W. Hetts, A. Turk, J.D. English, C.F. Dowd, J. Mocco, C. Prestigiacomo, G. Nesbit, S.G. Ge, J.N. Jin, K. Carroll, Y. Murayama, A. Gholkar, S. Barnwell, D. Lopes, S.C. Johnston, C. McDougall
American Journal of Neuroradiology Apr 2014, 35 (4) 698-705; DOI: 10.3174/ajnr.A3755

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Stent-Assisted Coiling versus Coiling Alone in Unruptured Intracranial Aneurysms in the Matrix and Platinum Science Trial: Safety, Efficacy, and Mid-Term Outcomes
S.W. Hetts, A. Turk, J.D. English, C.F. Dowd, J. Mocco, C. Prestigiacomo, G. Nesbit, S.G. Ge, J.N. Jin, K. Carroll, Y. Murayama, A. Gholkar, S. Barnwell, D. Lopes, S.C. Johnston, C. McDougall
American Journal of Neuroradiology Apr 2014, 35 (4) 698-705; DOI: 10.3174/ajnr.A3755
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