Steven William Hetts MD, Presenter: Consultant, Silk Road Medical Grant, Stryker Corporation

Aquilla Scott Turk DO, Abstract Co-Author: Scientific Advisory Board, Nfocus Consulting Inc Scientific Advisory Board, Pulsar Vascular, Inc Consultant, Stryker Corporation Consultant, Nfocus Consulting Inc Consultant, Pulsar Vascular, Inc Consultant, Johnson & Johnson Consultant, Penumbra, Inc Researcher, MindFrame, Inc Researcher, Pulsar Vascular, Inc Research funded, Siemens AG

Joey D. English MD, PhD, Abstract Co-Author: Consultant, Silk Road Medical Research Grant, Stryker Corporation

J. Mocco MD, Abstract Co-Author: Nothing to Disclose

Charles Prestigiacomo MD, Abstract Co-Author: Nothing to Disclose

Gary Nesbit MD, Abstract Co-Author: Nothing to Disclose

Sijian Grace Ge PhD, Abstract Co-Author: Employee, Stryker Corporation

Jinhua Nancy Jin PhD, Abstract Co-Author: Employee, Stryker Corporation

Yuichi Murayama, Abstract Co-Author: Research Grant, FUJIFILM Holdings Corporation Consultant, Stryker Corporation Consultant, Asahi Intecc Co, Ltd Inventor, Matrix Coil

Anil Gholkar MD, Abstract Co-Author: Consultant, Stryker Corporation Consultant, Johnson & Johnson

Stanley Barnwell MD, PhD, Abstract Co-Author: Nothing to Disclose

Demetrius Lopes, Abstract Co-Author: Consultant, Stryker Corporation

Y. Pierre Gobin MD, Abstract Co-Author: Royalties, Concentric Medical, Inc Stockholder, Concentric Medical, Inc Research Consultant, Nfocus Consulting Inc Stockholder, Nfocus Consulting Inc Stockholder, Lazarus Effect, Inc Director, Lazarus Effect, Inc

S. Claiborne Johnston, Abstract Co-Author: Consultant, Stryker Corporation

Cameron McDougall MD, Abstract Co-Author: Nothing to Disclose

Prior studies have reported stent-assisted coiling (SAC) may result in less aneurysm recanalization but more complications than coiling alone (CA). We evaluated outcomes of SAC in the prospective, multi-center MAPS Trial.

361 MAPS patients with unruptured intracranial aneurysms (UIA) were treated per protocol by SAC or CA. Data was analyzed post hoc for all UIAs and for the wide neck (>4mm) aneurysm (WNA) subset. Baseline patient and aneurysm characteristics, procedural details, neurological outcomes, and safety data were compared. An independent core laboratory evaluated all angiographic outcomes. Groups were not randomized to SAC or CA and are dissimilar, especially within the large UIA group.

137/361 patients received a Neuroform stent. Among UIAs, 62% of SAC vs. 33% of CA were WNA (P<0.0001) and the dome-to-neck ratio was lower for SAC than for CA (1.5 vs. 2.1, p<0.0001). For UIAs, packing density trended higher with SAC (26.2% vs. 24.2%, p=0.07). Among WNAs, SAC packing density was higher than CA (26.4% vs. 21.1% p=0.002). Periprocedural significant adverse events (SAEs) were similar between SAC and CA (6.6% vs. 4.5%, p=0.39). At 1 year, SAEs, mortality, and worsening of modified Rankin scores (mRS) were not different between SAC and CA. Among UIAs, SAC had a higher 1-year ischemic stroke rate (8.8% vs. 2.2% p=0.005). Of note, 42% of SAC ischemic strokes occurred at one enrolling site, exclusion of which brings the comparative stroke rates to 5.1% vs. 2.2%, respectively (p=0.22). There was no significant difference in ischemic stroke rates between SAC and CA within the more similar WNA subset. Complete angiographic obliteration rates for SAC were significantly higher than CA in the WNA subset at 1 year (45.7% vs. 27.1%, p=0.03). Angiographic worsening was lower for SAC than CA in both the UIA (16.7% vs. 33.3%, p=0.002) and WNA groups (21.4% vs. 50.8%, p=0.0005). Core lab analysis revealed no significant stent migration at 1 year.

SAC was safe and effective in treating UIAs in MAPS. SAC correlated with higher coil packing densities and better angiographic outcomes at 1 year without significantly higher rates of SAEs, mortality, death or disability despite the stented aneurysms having more difficult morphology than coiled aneurysms.

Stent assisted coiling is a promising treatment for unruptured wide necked aneurysms.

Hetts, S, Turk, A, English, J, Mocco, J, Prestigiacomo, C, Nesbit, G, Ge, S, Jin, J, Murayama, Y, Gholkar, A, Barnwell, S, Lopes, D, Gobin, Y, Johnston, S, McDougall, C, Stent Assisted Coiling vs Coiling of Unruptured Intracranial Aneurysms in the MAPS Trial: Safety, Efficacy, and Mid Term Outcomes.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12034077.html