A326 Angiographic and clinical outcomes of intrasaccular flow disruption, coiling, and stent-assisted coiling in patients with unruptured saccular intracranial aneurysms: a multicenter real-world study

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Background/Introduction Endovascular treatment has become the dominant therapeutic approach for unruptured intracranial aneurysms. However, real world comparative data evaluating the relative safety and efficacy of coiling, stent-assisted coiling (SAC), and intrasaccular flow disruption with the Woven EndoBridge (WEB) device remain limited, particularly in Latin American populations. Objective/Purpose The objective of this study was to compare the observed angiographic, clinical, and safety outcomes of simple coiling, SAC, and WEB in patients with unruptured intracranial saccular aneurysms treated across participating Colombian neurointerventional centers. Methods/Case Description We conducted a retrospective multicenter study across high-volume neurointerventional centers in Colombia (January 2014–January 2025), including adult patients with unruptured saccular intracranial aneurysms treated with coiling, WEB, or SAC. Clinical, anatomical, procedural, angiographic, and functional outcomes were analyzed. Efficacy and Safety outcomes were analyzed at 12 months. A wide-neck subgroup and logistic regression analysis was also performed. Results/Findings A total of 377 patients with 410 aneurysms were included. Mean age was 63.37 years, and 73.4% were women. SAC was used in 228 aneurysms, coiling with or without balloon assistance in 111, and WEB in 71. SAC achieved the highest rates of complete occlusion (83.77%) and adequate occlusion (96.46%), followed by coiling (75.22% and 94.44%, respectively), whereas WEB showed lower complete and adequate occlusion rates (67.60% and 71.42%, respectively). Retreatment rates were low and comparable across groups (3.60%, 4.22%, and 2.19%; p=0.596). No differences were observed in hemorrhagic complications, morbidity, or functional outcomes across groups, although global ischemic complications were higher in the SAC group (p=0.006). Discussion/Conclusions/Learning Points Excellent functional outcomes were achieved across all endovascular strategies. Stent-assisted coiling demonstrated the highest rates of complete and adequate occlusion, while coiling and WEB were associated with fewer ischemic complications.

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