Endovascular Embolization of Intracranial Aneurysms: To Use Stent(s) or Not? Systematic Review and Meta-analysis

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• 作者：Ming-tao Feng ; Wan-ling Wen ; Zheng-zhe Feng ; Yi-bin Fang ; Jian-min Liu ; ^{chstroke@163.com" class="auth_mail" title="E-mail the corresponding author} ; Qing-hai Huang ; ^{ocinhqh@163.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Coil ; Endovascular ; Intracranial aneurysms ; Stent ; Subarachnoid hemorrhage
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：93
• 期：Complete
• 页码：271-278
• 全文大小：3960 K

文摘

We sought to review the literature concerning stent-assisted coiling (SAC) in comparison with coiling without stents for treating intracranial aneurysms and to evaluate the safety and effectiveness of SAC by conducting a meta-analysis of published studies.

Methods

According to the methods and guidelines for meta-analysis, PubMed, Embase, and Cochrane Database were searched. All articles that compared SAC and coiling without stent were reviewed. The data extracted were the rates of immediate occlusion, progressive thrombosis, angiographic occlusion, angiographic recurrence, overall complications, ischemic stroke, and hemorrhagic stroke.

Results

Sixteen studies with 4294 aneurysms were analyzed. SAC was performed for 1466 aneurysms; and coiling without stent was performed for 2828 aneurysms. No significant difference in immediate occlusion rate was found between the 2 groups (odds ratio [OR] = 1.01; 95% confidence interval [CI], 0.73–1.39, P = 0.96). However, SAC had an advantage in terms of angiographic occlusion rate during follow-up (OR = 1.62, 95% CI: 1.16–2.26, P < 0.01), progressive thrombosis rate (OR = 2.54, 95% CI: 2.00–3.24, P < 0.01), and reduction in recurrence rate (OR = 0.46; 95% CI, 0.35–0.59, P < 0.01). No significant differences were shown in overall complication rate (OR = 1.30, 95% CI: 086–1.96, P = 0.21) and hemorrhagic stroke rate (OR = 0.72, 95% CI: 0.43–1.20, P = 0.21). Ischemic strokes were more common in the SAC patients than in the non–stent-assisted patients (OR = 1.66; 95% CI: 1.05–2.63, P = 0.03).

Conclusion

Compared with coiling without stent, stent-assisted coiling of intracranial aneurysms achieved satisfactory results, with higher long-term angiographic occlusion rate and lower recurrence rate. However, ischemic stroke remains a problem that cannot be ignored.