[Vascular endoprostheses in the treatment of intracranial aneurysms: a systematic review].
OBJECTIVE
To evaluate the effectiveness and safety of endovascular prostheses (stents) in the treatment of intracranial aneurysms.


METHODS
We performed a systematic review of the literature using the databases Medline, Embase, HTA, and the Cochrane Library. Relevant articles were selected by reading the abstracts found in the search and applying a series of inclusion and exclusion criteria. Afterwards, the entire text was read critically and the results were extracted and analyzed.


RESULTS
Only ten series fulfilled the inclusion criteria established, and different methodological limitations were observed. A total of 287 lesions were treated; 76 of these were wide-neck aneurysms, and total or nearly total occlusion was achieved in approximately 77% of cases. Among the 281 patients included, 14 deaths (4.9%) and 48 complications (17.1%) occurred; 55% of the complications were of thromboembolic origin. Moreover, in 71 cases (24.7%) there were difficulties in placing the stent, stent displacement, or other technical problems.


CONCLUSIONS
Despite the data reported in this review, the lack of methodologically sound studies with long-term follow-up as well as the methodological limitations and heterogeneity found in the observational studies included in this review make it impossible to reach definitive, categorical conclusions regarding the efficacy and safety of this technique. Therefore, it would be recommendable to initiate randomized clinical trials to compare this technique with other treatment options, using appropriate and homogeneous criteria for the selection of both patients and centers together with strict follow-up, registering, and evaluation of the results obtained.
Atienza Merino
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Agencia de Evaluación de Tecnologías Sanitarias de Galicia. Consellería de Sanidade. Santiago de Compostela. A Coruña. España. gerardo.atienza.merino@sergas.es
D001807:Blood Vessel Prosthesis; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome