Readmissions and retreatment among stent-assisted endovascular coiling patients with unruptured intracranial aneurysm using ENTERPRISE ® 2 stent versus LVIS™ stent

Aim: The treatment of wide-necked unruptured intracranial aneurysms (UIA) remains clinically challenging. Stent-assisted coiling (SAC) is a commonly used treatment modality for UIAs. The objective of this study was to examine the differences in 180-day all-cause inpatient readmissions, UIA-related inpatient readmission, and retreatment among UIA patients treated with the laser cut nitinol ENTERPRISE® 2 stent versus the braided nitinol LVIS™ stent during SAC procedures. Materials & methods: Using Premier Healthcare Database (PHD), a US nationwide hospital database, UIA patients aged ≥18 years old undergoing SAC were identified. Patients were then classified into ENTERPRISE 2 and LVIS cohorts based on the stent used. Study outcomes, including 180-day all-cause and UIA-related inpatient readmissions, and UIA-related retreatment, were compared between the two cohorts. Inverse probability of treatment weighting of propensity score approach was used to balance covariates (i.e., patient demographic, clinical characteristics and hospital characteristics) between the two study groups. Chi-square test and weighted generalized estimating equation (GEE) model was used to assess outcomes among the weighted ENTERPRISE 2 and LVIS cohorts. Results: A total of 249 patients were included after applying study inclusion and exclusion criteria (with 130 in the ENTERPRISE 2 cohort and 119 in the LVIS cohort). Patient characteristics were well balanced after weighting. Bivariate analysis revealed that patients undergoing stent-assisted endovascular coiling using ENTERPRISE 2 stent had a significantly lower rate of 180-day all-cause inpatient readmissions (9.1% vs 24.3%, chi-square p = 0.016) and a significantly lower rate of 180-day UIA-related inpatient readmission (2.6% vs 12.4%, chi-square p = 0.036) compared with those treated with LVIS stent. GEE regression model indicated that patients in the ENTERPRISE2 stent cohort were 69% less likely to have 180-day all-cause inpatient readmissions (odds ratio: 0.31, 95% CI: 0.12-0.82, GEE p = 0.018) versus the LVIS cohort. However, no significant difference in 180-day UIA-related inpatient readmission and 180-day UIA-related retreatment was observed in GEE analysis. Conclusion: Patients who were treated with the laser-cut ENTERPRISE 2 stent during endovascular coiling were observed to have significantly lower risk of all-cause inpatient readmissions compared with those treated with the braided LVIS stent. No significant differences were observed for 180-day UIA-related readmission and retreatment among the study cohorts.