Safety and efficacy of endovascular treatment of wide-neck intracranial aneurysms: comparison between stent-assisted coiling and intrasaccular flow disruption with the contour device

Q: What are the key findings of this study?

Stent-assisted coiling was associated with significantly more postprocedural DWI lesions than the Contour device (78% vs 43%, p<0.001; aOR 4.15, 95% CI 1.39-12.4, p=0.011).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Unruptured wide-neck intracranial aneurysms (n=96). Intervention: Stent-assisted coiling (SAC) vs. Contour Neurovascular System (intrasaccular flow disruption device). Primary outcome: Occurrence of new postprocedural diffusion-weighted imaging (DWI) lesions within 24-72 hours (aOR 4.15, 95% CI 1.39-12.4, p=<0.001).

Q: What does this research mean for the field?

In elective endovascular treatment of unruptured wide-neck intracranial aneurysms, stent-assisted coiling is associated with a significantly higher rate of postprocedural DWI lesions compared to intrasaccular flow disruption with the Contour device. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate whether endovascular treatment strategy affects the frequency of postprocedural DWI lesions, periprocedural complications, and retreatment rates in patients with unruptured wide-neck intracranial aneurysms.

Gregor Peter; Lukas Meyer; Luca Meucci; Vincent Geest; Felix Schlicht; Matthias Bechstein; Bogdana Tokareva; Christian Heitkamp; Laurens Winkelmeier; Helge C. Kniep; Maxim Bester; Jens Fiehler; Christian Thaler

doi:10.1007/s00234-026-04262-8

November 6, 2026NeuroradiologyOpen Access

Safety and efficacy of endovascular treatment of wide-neck intracranial aneurysms: comparison between stent-assisted coiling and intrasaccular flow disruption with the contour device

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Key result

Stent-assisted coiling is linked to ~4.2-fold higher odds of postprocedural DWI lesions than Contour.

aOR 4.15
95% CI 1.39-12.4
P<0.001
n=96

Why the study?

The association between endovascular treatment strategy and the occurrence of postprocedural DWI lesions, periprocedural complications, and retreatment rates in patients undergoing elective endovascular treatment for unruptured wide-neck intracranial aneurysms needed investigation.

Does intrasaccular flow disruption with the Contour device reduce postprocedural DWI lesions and periprocedural complications compared to stent-assisted coiling in patients undergoing elective endovascular treatment for unruptured wide-neck intracranial aneurysms?

Key Points

To investigate whether endovascular treatment strategy affects the frequency of postprocedural DWI lesions, periprocedural complications, and retreatment rates in patients with unruptured wide-neck intracranial aneurysms.
Retrospective single-center study evaluating consecutive patients (N=96) undergoing elective endovascular repair with stent-assisted coiling (SAC, n=48) or the Contour device (CD, n=48) between January 2019 and January 2026.
Wide-neck aneurysms were defined by a neck width ≥4 mm, a dome-to-neck ratio < 2, or both.
Primary outcomes included postprocedural magnetic resonance imaging assessment for new DWI lesions and periprocedural complications, analyzed with uni- and multivariable logistic regression.
Postprocedural DWI lesions appeared in 60% of patients overall, occurring significantly more often after SAC than CD (78% vs. 43%; p <0.001), with SAC independently predicting DWI lesions (aOR 4.15, 95% CI 1.39–12.4, p = 0.011).
Periprocedural complication rates (13% SAC vs. 13% CD; p = 1.0) and retreatment rates (7% SAC vs. 6% CD; p = 0.754) did not differ between groups.
Procedure times were significantly longer for SAC (112 min vs. 85 min; p = 0.001), while the CD group exhibited significantly more cases of residual aneurysm perfusion at follow-up (31% vs. 17%; p = 0.034).

Study Design

Type

Cohort (n=96)

Blinding

Single-blind (outcome assessment)

Multicenter

No

Structured PICO

Does intrasaccular flow disruption with the Contour device reduce postprocedural DWI lesions and periprocedural complications compared to stent-assisted coiling in patients undergoing elective endovascular treatment for unruptured wide-neck intracranial aneurysms?

P

Population

96 adults (mean age 58 years, 71% female) undergoing elective endovascular treatment for unruptured wide-neck intracranial aneurysms at a single center in Germany, followed for 6 months.

E

Exposure

Intrasaccular flow disruption with the Contour device (ranging from 5 to 14 mm, with adjunct coiling in 5 patients), preceded by aspirin 100 mg and clopidogrel 75 mg (or ticagrelor in non-responders) for 7 days, 5000 IU intravenous heparin intraprocedurally, and followed by aspirin 100 mg for 6 weeks.

C

Comparator

Stent-assisted coiling (SAC) using laser-cut or braided stents via single stent, Y-stenting, or shouldering technique (standardly jailing technique), preceded by aspirin 100 mg and clopidogrel 75 mg (or ticagrelor in non-responders) for 7 days, 5000 IU intravenous heparin intraprocedurally, and followed by aspirin 100 mg indefinitely and clopidogrel 75 mg (or ticagrelor 90 mg) for 6 months.

O

Outcome

Occurrence of new postprocedural diffusion-weighted imaging (DWI) lesions on brain MRI within 24–72 hours (validated by board-certified neuroradiologists blinded to access route and implanted device) and periprocedural complications (such as hemorrhagic or thromboembolic events).safety

Main Result

Odds Ratio: 4.15 (95% CI 1.39–12.4)

Absolute Event Rate: 78% vs 43%

p-value: p=<0.001

In patients undergoing elective endovascular treatment for unruptured wide-neck intracranial aneurysms, stent-assisted coiling is associated with a significantly higher rate of subclinical postprocedural ischemic DWI lesions compared to the Contour device, though clinical complication and short-term retreatment rates are similar.

Limitations

Retrospective, single-center design limiting generalizability
Non-randomized treatment allocation introducing potential selection bias and residual confounding
Small sample size precluding propensity score matching
Short 6-month follow-up duration with incomplete angiographic follow-up (available in 77 of 96 patients)
Lack of standardized long-term neurological and neurocognitive assessments
Preprocedural DWI was not systematically available in all patients to exclude pre-existing silent ischemic lesions
Technical heterogeneity within the stent-assisted coiling group (different stent designs and deployment techniques)
Retrospective, single-center design limiting generalizability and introducing potential selection bias and confounding
Non-randomized treatment allocation at the discretion of the treating physician
Follow-up limited to 6 months and incomplete (angiographic follow-up available in 77 of 96 patients)
Preprocedural DWI was not systematically available within a standardized imaging window for all patients

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Answers are grounded in this paper and cite their sources.

Implication

SAC-associated DWI lesions should not yet change practice; leaves open clinical relevance versus Contour in wide-neck aneurysms.

Abstract

Purpose To investigate the association between endovascular treatment strategy and the occurrence of postprocedural DWI lesions and periprocedural complications as well as retreatment rates in patients undergoing elective endovascular treatment (EVT) for unruptured wide-neck intracranial aneurysms. Methods This retrospective single-center study includes all consecutive patients who underwent elective EVT with stent-assisted coiling (SAC) or Contour device (CD) of unruptured wide-neck intracranial aneurysms between January 2019 and January 2026. Wide-neck aneurysms were defined as aneurysms with a neck ≥4 mm and/or a dome-to-neck ratio < 2. Postprocedural MRI was assessed for new DWI lesions. Uni- and multivariable regression analysis was performed to identify predictors for the primary outcome variables DWI lesions and periprocedural complications. Secondary outcome variables included procedure time, residual perfusion and retreatment rates. Results A total of 96 patients (50% SAC, 50% CD) were included. Postprocedural DWI lesions were detected in 60% of patients overall with a significant difference between the two groups (78% SAC vs. 43% CD; p <0.001). Periprocedural complications (SAC 13% vs. CD 13%; p = 1.0) and retreatment rates (SAC 7% vs. CD 6%; p = 0.754) did not differ between the two groups. In a multivariate regression analysis, SAC (aOR 4.15, 95% CI 1.39–12.4, p = 0.011) was an independent predictor of postprocedural DWI lesions. Conclusion In elective EVT of unruptured wide-neck intracranial aneurysms, stent-assisted coiling was associated with a significantly higher rate of postprocedural DWI lesions compared to the Contour device. Periprocedural complications and retreatment rates were similar between the treatment strategies.

Discussion

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Cite This Study

Peter et al. (2026) conducted a cohort in Unruptured wide-neck intracranial aneurysms (n=96). Stent-assisted coiling (SAC) vs. Contour Neurovascular System (intrasaccular flow disruption device) was evaluated on Occurrence of new postprocedural diffusion-weighted imaging (DWI) lesions within 24-72 hours (aOR 4.15, 95% CI 1.39-12.4, p=<0.001). Stent-assisted coiling was associated with significantly more postprocedural DWI lesions than the Contour device (78% vs 43%, p<0.001; aOR 4.15, 95% CI 1.39-12.4, p=0.011).

synapsesocial.com/papers/6aefbd4950d2071ffda4bc35 https://doi.org/10.1007/s00234-026-04262-8

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Safety and efficacy of endovascular treatment of wide-neck intracranial aneurysms: comparison between stent-assisted coiling and intrasaccular flow disruption with the contour device

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Safety and efficacy of endovascular treatment of wide-neck intracranial aneurysms: comparison between stent-assisted coiling and intrasaccular flow disruption with the contour device

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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