Comparison of efficacy and safety between Neuroform Atlas stent-assisted coiling and coiling alone for irregular intracranial aneurysms: a single-center retrospective study.

The Neuroform Atlas stent-assisted coiling (SAC) technique offers theoretical advantages for the treatment of irregular intracranial aneurysms (IIAs); however, comparative data with coiling alone remain limited. This study aimed to compare angiographic and clinical outcomes between SAC and coiling alone in patients with IIAs. This single-center retrospective study included patients with IIAs treated between January 2022 and December 2023. Patients were divided into the SAC group and the coiling alone group. The primary outcome was the complete occlusion rate at the last angiographic follow-up. A total of 210 aneurysms were included (103 SAC, 107 coiling alone). Significant baseline imbalances were present: the SAC group had wider necks (4.27 ± 1.54 vs. 3.55 ± 1.26 mm, P < 0.001), smaller dome-to-neck ratios (1.29 ± 0.48 vs. 1.77 ± 0.80, P < 0.001), and importantly, a higher proportion of unruptured aneurysms (42.7% vs. 14.0%, P < 0.001). No significant difference was observed in immediate complete occlusion (84.5% vs. 91.6%, P = 0.111). At the last angiographic follow-up (mean 6-8 months), the SAC group had a higher complete occlusion rate (93.0% vs. 74.6%, P = 0.004) and a lower recurrence rate (5.6% vs. 22.0%, P = 0.012). The incidence of favorable discharge outcomes (mRS ≤ 2) was higher in the SAC group (89.3% vs. 74.8%, P = 0.006), but this difference was not sustained at 1 year (90.3% vs. 85.0%, P = 0.249). Hospitalization costs were higher in the SAC group (20,906vs.20,906vs.18,284, P = 0.008). Asymptomatic cerebral infarction occurred more frequently in the SAC group (16.5% vs. 7.5%, P = 0.043). Neuroform Atlas SAC was associated with higher long-term complete occlusion rates and lower recurrence compared with coiling alone for IIAs, but also with higher costs and more asymptomatic cerebral infarctions.