Endovascular stent-assisted coil embolization for aneurysm treatment: clinical outcomes at 12 months

Wide-necked unruptured intracranial aneurysms pose a challenge for endovascular treatment. Previous studies have compared stent-assisted coiling (SAC) and balloon-assisted coiling (BAC), but additional contemporary data in narrowly defined cohorts of wide-necked, unruptured anterior-circulation aneurysms remain clinically useful. To compare immediate occlusion efficacy, perioperative safety, and 12-month angiographic stability between SAC and BAC for wide-necked unruptured anterior circulation aneurysms. This retrospective cohort study included 120 patients treated between January 2023 and January 2025, with 58 undergoing BAC and 62 undergoing SAC. Primary endpoints were immediate complete occlusion rates and 12-month recurrence-free survival. Secondary endpoints included procedural parameters, perioperative complications, and functional outcomes at 6 and 12 months. A focused multivariable logistic regression model was used to evaluate immediate complete occlusion after adjustment for key anatomical variables. Baseline characteristics were comparable between groups. SAC achieved significantly higher immediate complete occlusion rates than BAC (87.10% vs. 63.79%, P = 0.006). After adjustment for aneurysm size, neck width, and dome-to-neck ratio, SAC remained independently associated with immediate complete occlusion (adjusted OR 4.22, 95% CI 1.63–10.92, P = 0.003). At 12 months, recurrence-free survival rates were 88.71% in the SAC group and 79.31% in the BAC group ( P > 0.05). Perioperative complication rates were similar between groups (8.06% vs. 10.34%, P > 0.05). Favorable functional outcomes (mRS 0–2) at 6 months were observed more frequently in the SAC group than in the BAC group (100.00% vs. 89.66%, P = 0.011), with no significant difference at 12 months. For wide-necked unruptured anterior circulation aneurysms, SAC was associated with a higher immediate complete occlusion rate than BAC, while perioperative complications, 12-month recurrence-free survival, retreatment, and 12-month functional outcomes did not differ significantly between groups.