Stent-assisted coiling versus simple coiling for ruptured intracranial aneurysms in the acute phase: A single-center retrospective cohort study

Objective: To compare intraprocedural complications, follow-up angiographic occlusion, and functional outcomes between stent-assisted coiling (SAC) and simple coiling for ruptured intracranial aneurysms treated during acute subarachnoid hemorrhage. Methods: We retrospectively analyzed 217 patients treated from March 2018 to January 2026 (SAC, n=97; simple coiling, n=120). Follow-up angiographic analysis used the latest evaluable digital subtraction angiography (DSA) in survivors. Multivariable logistic regression evaluated intraprocedural complications, complete occlusion, and poor follow-up functional outcome; sensitivity analyses tested alternative covariate sets. Results: Wide-neck morphology was more frequent in the SAC group (79.4% vs. 49.6%, p=5.71×10-6. Angiographically detected intraprocedural complications were more frequent after SAC (29.9% vs. 12.5%, p=0.002), and SAC remained associated with this endpoint in the primary model (adjusted odds ratio [aOR] 2.33, 95% confidence interval [CI] 1.07-5.08; p=0.033). The Raymond-Roy Occlusion Classification (RRC) distribution differed between groups (p=0.020), with complete occlusion in 43/54 (79.6%) versus 38/68 (55.9%). SAC was associated with complete occlusion after adjustment (aOR 2.59, 95% CI 1.06-6.32; p=0.037). Poor follow-up outcome did not differ (45.6% vs. 42.5%, p=0.672), and SAC was not independently associated with poor outcome. Conclusions: SAC was associated with a higher incidence of angiographically detected intraprocedural complications and more favorable follow-up angiographic occlusion in selected morphologically unfavorable ruptured aneurysms. A functional benefit was not demonstrated.