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

Background: 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 Key points: Subarachnoid hemorrhage, intracranial aneurysms, Stent-assisted coiling, Complication