Wide necked unruptured aneurysm [Neurosurgery Wiki]

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=====Wide necked unruptured aneurysm=====
In the [[endovascular treatment]] of wide-necked [[unruptured aneurysm]]s, there is controversy over which adjunctive device (stent vs balloon) is appropriate. At the payer level it has been posited that [[stent]]s and [[balloon]]s treat the same aneurysms, and, as such, the more expensive stents should not be reimbursed.

One hundred six unruptured aneurysms were treated with an adjunctive device and followed for a mean of 24.5 months. Morphological analysis revealed a lower dome-to-neck ratio (1.5 vs 1.2) and aspect ratio (1.44 vs 1.16) in the [[aneurysm]]s treated with stent assistance vs balloon assistance. Of the 15.3% that were worse on follow-up angiography, there was no statistical difference between those treated with a stent vs a balloon (17.1% vs 14.2%). The overall re-treatment rate was 10.2% and was not statistically different between the 2 groups (12.7% vs 5.7%).

Peterson et al., found that unruptured aneurysms selected for treatment with stent-assisted coiling are morphologically different from those selected for treatment with balloon assistance. Despite the more challenging morphology, [Raymond Roy occlusion classification]] and re-treatment rates at 1 year were not statistically different between the 2 groups, suggesting an important role for stents in the treatment of unruptured aneurysms
((Peterson E, Hanak B, Morton R, Osbun JW, Levitt MR, Kim LJ. Are aneurysms
treated with balloon-assisted coiling and stent-assisted coiling different?
Morphological analysis of 113 unruptured wide-necked aneurysms treated with
adjunctive devices. Neurosurgery. 2014 Aug;75(2):145-51. doi:
10.1227/NEU.0000000000000366. PubMed PMID: 24739363.
))