Neurovascular-Nuggets_ Unpacking SAC vs. Coiling for Aneurysms – Is Less Sometimes More_
Notas del episodio
🎁key points from the article - This was a randomized trial comparing stent-assisted coiling (SAC) versus coiling alone (CA) for unruptured intracranial aneurysms at high risk of recurrence (large, recurrent, or wide-neck aneurysms). - 205 patients were randomized, with 94 allocated to SAC and 111 to CA. The primary outcome was a composite of treatment failure, defined as initial failure, aneurysm rupture, retreatment, death/disability, or residual aneurysm at 12 months imaging. - The primary outcome occurred in 30.1% with SAC versus 27.3% with CA (relative risk 1.10, p=0.66). There was no significant difference in rates of 12-month morbidity/mortality or retreatment. - As-treated analysis showed lower residual aneurysm rates with SAC but higher complication rates compared to CA. - The study did not find evidence that SAC improves outcomes compared to CA in high-risk unruptured aneurysms. 💡Clinical Implications: - The results do not support routine use of SAC over CA in unruptured intracranial aneurysms, even those at higher recurrence risk. - SAC may increase procedural risks without improving clinical outcomes compared to CA. However, the study was underpowered for definitive safety conclusions. - Careful consideration of risks versus benefits is warranted before routinely using SAC instead of CA in eligible unruptured aneurysm patients. - Larger randomized trials could help clarify if subsets of aneurysms benefit from SAC over CA. Integrating future SAC studies into ongoing trials may be useful. In summary, this randomized trial did not find evidence to support superiority of SAC over CA for unruptured intracranial aneurysms prone to recurrence. The results argue against routine use of SAC in eligible patients, though larger studies are needed to guide optimal patient selection. Read more at https://lnkd.in/dwisZ3VA