A single center comparison of coiling versus stent assisted coiling in 90 consecutive paraophthalmic region aneurysms

Safety and cost of stent-assisted coiling of unruptured intracranial aneurysms compared with coiling or clipping

OBJECTIVE

Stent-assisted coiling (SAC) of unruptured intracranial aneurysms is a treatment alternative to clipping or coiling, although high complication and procedure-related mortality rates have been reported.

METHODS

A retrospective study was conducted of patients undergoing SAC, coiling or clipping of unruptured intracranial aneurysms between 2003 and 2010. Rates of residual aneurysm, recanalization, complications, cost (adjusted to 2010), length of stay (LOS) and outcome were compared between groups.

RESULTS

Of 116 subjects, 47 underwent SAC, 33 coiling and 36 clipping. The groups were similar in age, gender and aneurysm location, although the SAC group had significantly larger aneurysms with wider necks (p=0.001). Patients who underwent SAC had more residual aneurysm after initial treatment than those treated with coiling or clipping (75%, 52% and 19%, respectively, p<0.0001), but this difference was smaller at follow-up angiography (50%, 50% and 17% residual, respectively) and was not significant after adjusting for baseline aneurysm and neck size. SAC was not associated with increased recanalization, requirement for additional treatment, mortality or complications after adjusting for aneurysm and neck size. Patients who underwent SAC and those who underwent coiling were more likely to have a good discharge disposition than patients treated with clipping (100% vs 91%, p=0.042). LOS was significantly shorter for patients who underwent SAC or coiling compared with those treated with clipping (p<0.0001). The overall direct cost was higher for patients who underwent SAC than for those treated with coiling or clipping (median $22 544 vs $12 933 vs $14 656, p=0.001), even after adjusting for aneurysm and neck size, LOS and retreatment.

CONCLUSIONS

SAC is a safe alternative to coiling or clipping of unruptured aneurysms but it is currently more expensive.

Cost Comparison of Endovascular Treatment of Anterior Circulation Aneurysms With the Pipeline Embolization Device and Stent-Assisted Coiling

BACKGROUND:

The Pipeline embolization device (PED) is a new endovascular option for wide-necked or fusiform anterior circulation aneurysms that were classically treated by coil embolization with adjunctive use of a stent. However, stent-coiling incurs significant equipment and implant costs.

OBJECTIVE:

To determine whether PED embolization is more economical than stent-assisted coiling.

METHODS:

Sixty consecutive patients with anterior circulation aneurysms who underwent treatment with the PED (30 patients) or by single-stage stent-assisted coiling (30 patients) were identified from a prospective single-center aneurysm database. The hospital costs of equipment and implants were analyzed and compared for each group.

RESULTS:

The mean aneurysm size for patients treated with the PED was 9.8 vs 7.3 mm for patients treated by stent-assisted coiling. The total combined costs of proximal access/guide catheters, microcatheters, and microwires were equivalent between the 2 groups. The cost of implants, however, was significantly lower in the PED group ($13 175 ± 726 vs $19 069 ± 2015; P = .013), despite this group having a larger mean aneurysm size. Furthermore, the total procedure cost was significantly lower for the PED group vs the stent-coiling group ($16 445 ± 735 vs $22 145 ± 2022; P = .02), a 25.7% cost reduction. This represents a 27.1% reduction in the cost per millimeter of aneurysm treated in the PED group ($2261 ± 299) vs the stent-coiling group ($3102 ± 193; P = .02).

CONCLUSION:

Treatment of anterior circulation aneurysms by flow diversion with the PED has lower procedure costs compared with treatment with traditional stent-assisted coiling.