Comparison of Stent-assisted Coiling and Coiling Alone for Acutely Ruptured Intracranial Aneurysms:The SANE Multicenter Registry

  1. Hailong Zhong
  2. Xiaopeng Xue
  3. Fei Peng
  4. Xin Tong
  5. Xin Feng
  6. Jing Li
  7. Zhiqun Jiang
  8. Wei Hu
  9. Sheng Guan
  10. Changming Wen
  11. Qingrong Zhang
  12. Zongduo Guo
  13. Tian Tian
  14. Ying Xia
  15. Hongguang Wang
  16. Jianjun Yu
  17. Youle Su
  18. Yongli Li
  19. Xiang Xu
  20. Zhenbao Li
  21. Meng Zhang
  22. Hui Ma
  23. Mengqiang Yu
  24. Changchun Jiang
  25. Zhong Wang
  26. Jing Luo
  27. Jun Huang
  28. Li Pan
  29. Ning Ma
  30. Xia Li
  31. Zhen Wang
  32. Jiasheng Yu
  33. Jianqiang Qu
  34. Shengqing Lv
  35. Aisha Maimaitili
  36. Xuebin Hu
  37. Wanfu Xie
  38. Zhihong Zhao
  39. Bing Wang
  40. Yuesong Pan
  41. Chuanzhi Duan
  42. Xunming Ji
  43. Aihua Liu
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Abstract

Evidence from large, prospective studies in treating ruptured intracranial aneurysms (RIAs) using stent-assisted coiling (SAC) technique is lacking, biases and uncertainty regarding the safety of SAC persist. We aimed to evaluate the safety and efficacy of SAC compared to coiling alone (CA) for treatment RIAs.

Methods

We conducted an observational registry of patients with subarachnoid hemorrhages (SAH) caused by RIAs treated with endovascular treatment at 33 centers from 20 provinces at China between April 2021 and February 2024. The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0-2 at one-year follow-up. Multivariable logistic regression and propensity-score matching were performed to evaluate favorable functional outcome, perioperative complications and angiographic results.

Results

Among the 3353 enrolled patients, the median age of patients is 58 years old (IQR, 50 - 66), 66.7% were female. After adjustment for confounders, there was no significant difference between SAC and CA in the rate of favorable functional outcomes (87.9% vs. 88.1%; adjusted odds ratio [aOR], 1.020 [95% CI, 0.820– 1.270]). Compared with the CA group, the SAC group had a higher incidence of intraprocedural thrombosis (4.2% vs. 1.8%; aOR, 3.097 [95% CI, 1.950–4.920]) and postoperative cerebral infarction (9.7% vs. 8.2%; aOR, 1.293 [95% CI, 1.007– 1.660]). At angiographic follow-up, the SAC group demonstrated a higher rate of complete occlusion (80.3% vs. 63.8%; aOR, 2.848 [95% CI, 2.344–3.460]) and a lower recurrence rate (7.7% vs. 20.4%; aOR, 0.289 [95% CI, 0.224–0.373]).

Conclusions

Despite a more than two-fold increase in intraoperative thrombosis risk, SAC for RIAs achieved comparable functional and superior immediate and long-term angiographic outcomes to CA, supporting its status as a safe and effective strategy.

Registration: https://www.chictr.org.cn , ChiCTR2000032657

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  1. Version published to 10.1101/2025.09.22.25336406 on medRxiv