{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T13:43:22Z","timestamp":1764596602515,"version":"3.46.0"},"reference-count":30,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T00:00:00Z","timestamp":1764374400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background and purpose: Stent-assisted coiling (SAC) achieves immediate aneurysm occlusion, while flow diversion (FD) promotes progressive remodeling. Comparative data in unruptured anterior circulation aneurysms remain limited. Methods: A retrospective review of our institutional database was conducted between 2021 and 2024. A total of 129 aneurysms treated with SAC (n = 33) or FD (n = 96) were identified and included in the analysis. Outcomes included angiographic occlusion, retreatment, complications, and the modified Rankin Scale (mRS). A 1:1 propensity score matching (PSM) was performed on sex, age, aneurysm size, and location (caliper 0.2, exact sex matching). Results: A total of 130 patients (89 women, 41 men) were included in the study, with a mean age of 59.8 years (range 22\u201381). In the full cohort, SAC achieved higher immediate complete occlusion (62.5% vs. 8.3%, p &lt; 0.001), while FD demonstrated superior long-term stability (71.9% vs. 60.6%). Retreatment occurred in 18.2% of SAC cases and none with FD (p &lt; 0.001). Complication rates were comparable overall: intraoperative (15.2% SAC vs. 10.4% FD, p = 0.37), periprocedural \u226472 h (15.2% vs. 8.3%, p = 0.34), and delayed \u226512 months (9.1% vs. 10.4%, p = 0.85). In patients aged 70\u201380 years, periprocedural complications were more frequent with SAC (37.5% vs. 5.9%, p = 0.08). Functional independence (mRS 0\u20132) at last follow-up was 87.9% for SAC and 89.6% for FD (p = ns). In the matched cohort, SAC preserved higher immediate occlusion (60% vs. 10%, p &lt; 0.001), whereas FD provided greater long-term occlusion (65% vs. 55%, p = 0.33) and required no retreatments versus 15% in SAC (p &lt; 0.001). Subgroup analysis showed that SAC-related complications were largely confined to complex Y\/T-stent reconstructions for MCA bifurcation and AComA aneurysms, while single-stent SAC demonstrated a safety profile comparable to FD. Conclusions: SAC offers rapid angiographic exclusion but at the cost of higher retreatment. FD ensures durable occlusion and absence of retreatment, with a consistent safety profile. After stratification by technical complexity, excess morbidity associated with SAC originated from anatomically demanding multistent constructs, whereas single-stent SAC showed safety comparable to FD. Age may influence periprocedural risk, particularly with SAC. These findings reinforce a tailored strategy: \u201cClose fast with SAC, close forever with FD.\u201d<\/jats:p>","DOI":"10.3390\/brainsci15121290","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T09:34:37Z","timestamp":1764581677000},"page":"1290","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stent-Assisted Coiling vs. Flow Diversion in Unruptured Anterior Circulation Aneurysms: A Single-Center Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8024-4712","authenticated-orcid":false,"given":"Mario","family":"Martinez-Galdamez","sequence":"first","affiliation":[{"name":"Interventional Neuroradiology Unit, Radiology Department, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9703-0094","authenticated-orcid":false,"given":"Jorge","family":"Galv\u00e1n-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Unit, Radiology Department, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5704-1397","authenticated-orcid":false,"given":"Lorenzo Ismael","family":"Perez-Sanchez","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Unit, Radiology Department, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3351-668X","authenticated-orcid":false,"given":"Miguel Arturo","family":"Sch\u00fcller-Arteaga","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Unit, Radiology Department, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9780-6622","authenticated-orcid":false,"given":"Fausto Andres","family":"Vasconez-Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Unit, Radiology Department, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1114-2026","authenticated-orcid":false,"given":"Israel","family":"Sanchez-Lite","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Unit, Radiology Department, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4787-9839","authenticated-orcid":false,"given":"Carlos Alberto","family":"Rodriguez-Arias","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1177\/23969873221099736","article-title":"European Stroke Organisation guideline on management of unruptured intracranial aneurysms","volume":"7","author":"Etminan","year":"2022","journal-title":"Eur. 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