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

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.