Page 35 - ITPS-7-1

INNOSC Theranostics and
Pharmacological Sciences Antiplatelet treatments in neurological patients

time has expanded the utility of SAC to improve outcomes and recanalization, which affect 1% and 6.6% of patients,
for aneurysms in smaller vessels [79-81] . Hence, recent studies respectively. The Glasgow Outcome Scale was used to
have explored utilizing SAC in patients with intracranial analyze the extent of impaired consciousness in these
aneurysms. cases. About 80.7% of patients had a score of 5 or above at
[85]
The major complications of coiling aneurysms arise a 30-day follow-up, which later increased to 83.9% . With
due to a lack of regulatory control over the migration this data, the study concluded that SAC is an effective and
and deposition of the coil. The wide variety of stents that safe way to treat wide-necked intracranial aneurysms, with
can be used provides an additional level of modulation lower risks of complications and higher rates of success.
to have the optimal effect for each distinct aneurysm in Another study by Chalouhi et al. analyzed 461 elective
[84]
every patient. Aneurysms with different proportions may SAC procedures . They found favorable outcomes in 99%
require a different stent material or density to achieve the of these patients. About 87% of patients were available
desired outcome. One study by Masuda et al. classified for follow-up at 26 months, who had recanalization
[84]
aneurysms by size and identified mesh wire densities that and retreatment rates of 12% and 6.4%, respectively .
allowed for the greatest change in flow velocity through Overall, both studies concluded that SAC is a safe and
the aneurysm . Aneurysm size can be classified into the efficacious procedure with minimal complications that
[82]
following categories: small, medium, large, and giant . can significantly improve the prognosis of patients with
[83]
Masuda et al. determined that a 46.2% mesh density led to aneurysms.
the greatest change in blood flow for every aneurysm. This Numerous research studies have evaluated the
mesh density, however, had different effects on aneurysms prevalence of adverse effects following SAC compared
of different sizes. Aneurysms smaller than 4.0 mm showed to non-SAC procedures. The results of these studies are
an 80% reduction in blood flow, whereas giant aneurysms summarized in Table 2. Most studies noted no significant
greater than 25.0 mm showed a blood flow reduction of differences in adverse effects between SAC and non-SAC.
only 50% . Hence, the mesh density can be changed to Piotin et al., however, reviewed 1049 cases of aneurysm
[81]
achieve the appropriate blood flow reduction in aneurysms coiling and found that SAC was associated with more
with different dimensions. Another study by Piotin et al. adverse effects than non-SAC . Patients undergoing
[60]
found that stents with a higher packing density were SAC faced 4.6% of procedural complications and 7.4% of
[60]
associated with a lower rate of angiographic recurrence . permanent neurological procedure-related complications
Hence, mesh density can be adjusted to create an optimal compared to 1.2% and 3.8% of patients, respectively, with
stent that allows for improved outcomes in coiling for non-SAC . One limitation of the study that must be taken
[60]
aneurysms. into consideration is that around 40 – 50% of patients in
SAC, however, is not without risks. Accessing both groups were lost to long-term follow-up; therefore,
aneurysms surgically always carries a risk of morbidity the conduction of more comprehensive studies is needed
due to procedure-related complications and the potential in the future to draw more definitive conclusions. In
aneurysm rupture . Possible complications of SAC addition, different stent types were used in this study,
[84]
include the piercing of vessels, thromboembolic events, including balloon-expandable models and self-expandable
and hemorrhaging . An additional issue that can arise stents, but no significant difference was noted in their
[85]
if the stent becomes occluded is in-stent stenosis, which outcomes. Despite potential differences in conclusions
contributes to blood flow reduction within the parent artery regarding adverse outcomes, data from all of these studies
to the extent of pathological level . These complications, show that SAC improved long-term outcomes for patients
[86]
however, typically have a prevalence of < 7%, and most when compared to non-SAC. Multiple studies found lower
of these risks can be attributed to aneurysm size, older rates of recurrence, reduced recanalization rates, and
patient age, sensitive aneurysm location, or issues from a improvements in clinically acceptable levels of occlusion in
previously coiled aneurysm . patients who had undergone SAC. These large-scale studies
[84]
imply that SAC has significant utility in the treatment of
In recent years, numerous studies analyzed the safety
and efficacy of SAC with regard to complication rates. For intracranial aneurysms. Despite the differences observed
instance, one retrospective study by Aguilar-Salinas et al. between SAC and non-SAC procedures, more studies are
evaluated data from 124 patients with unruptured wide- needed to validate these findings and analyze their impacts
necked intracranial aneurysms . Only 3.3% of these on patient’s quality of life.
[85]
patients experienced complications from the procedure, As safety and efficacy of SAC are continuously
such as vessel occlusion or aneurysm rupture. These evaluated, the appropriateness of use for SAC changes
patients also had a low risk of severe in-stent stenosis over time. For instance, SAC is now regarded as a useful

Volume 7 Issue 1 (2024) 7 https://doi.org/10.36922/itps.1202