A188 Endovascular versus microsurgical clipping for wide-neck intracranial aneurysms: results from the stroke thrombectomy and aneurysm registry (STAR)

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Background/Introduction It is unclear if wide-necked aneurysms (WNA) benefit from endovascular therapy (EVT) or open surgery (OS). Objective/Purpose Analyze angiographic and functional outcomes of patients with WNA from the Stroke Thrombectomy and Aneurysm Registry (STAR). Methods/Case Description The STAR database involved patients from 9 institutions across the United States, Europe and Asia admitted from 2013 to 2025.Patients with underlying WNA and available clinical and angiographic follow-up at 3 years were included. WNA was defined as an intracranial aneurysm with a neck width ≥ 4 mm or a dome to neck ratio < 2.Rates of intraoperative aneurysm rupture, retreatment and clinical outcome at follow-up were also analyzed. Angiographic occlusion outcomes were reported based on the Raymond Roy Occlusion Classification. Functional outcomes were based on the modified Rankin Scale at discharge and 3 years. Multivariable logistic regression was performed. Results/Findings A total of 407 WNAs were ultimately included in this analysis. From this, 374/407 (91.9%) were unruptured and 33/407 (8.2%) were ruptured. Among the unruptured group, 301/374 (80.5%) underwent EVT and 73/374 (19.5%) had OS. Of the ruptured WNA, 25/33 (75.7%) had EVT and 8/33 (24.3%) underwent OS. Intraoperative aneurysm rupture (0.6% vs 3.7%, p = 0.05) and retreatment (6.8% vs 1.2%, p = 0.06) were similar among groups. Immediate Raymond Roy (I) was more likely to occur with OS (OR 43.90, 95% CI 13.5 - 270, p < 0.001) but was similar at 3 years (OR 3.45, 95% CI 1.00 - 21.70, p = 0.10). No difference was found in functional independence at discharge, one or three years. Discussion/Conclusions/Learning Points OS achieved immediate complete occlusion among WNAs but no difference was found at 3 years compared to EVT. Both treatment modalities had similar complication rates and functional outcomes.

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