Safety and efficacy of stent placement for treatment of intracranial aneurysms: a systematic review.
OBJECTIVE
To evaluate the safety and efficacy of stent placement for the treatment of complex intracranial aneurysms.


METHODS
We searched six databases, including Pubmed, Embase, SCI-expanded, the Cochrane Library, ISI Proceedings and ProQuest Dissertations & Theses for the relevant studies using multiple key words from December, 1997 to February, 2009.


METHODS
Thirty-three studies about stent placement for intracranial aneurysms were identified, which reported data from a total of 1069 patients with 1121 intracranial aneurysms.


METHODS
We prepared a standardized data extraction form (DEF), which was used by two independent researchers to extract data from the included 33 studies.


RESULTS
The overall initial complete occlusion rate was 52.5% (456/869, 95%CI: 49.2% - 55.8%). The overall complication rate was 14.3% (162/1130, 95%CI: 12.3% - 16.4%), of which 3.6% (38/1044, 95%CI: 2.5% - 4.8%) were permanent. Clinical follow-up showed a dependence rate of 8.4% (39/465, 95%CI: 5.9% - 10.9%). Angiographic follow-up showed an improvement rate of 24.3% (117/481, 95%CI: 20.5% - 28.2%) and a recurrence rate of 12.9% (62/481, 95%CI: 9.9% - 15.9%). Chi-squared tests were performed to compare the following subgroups: self-expandable vs. balloon-expandable stents, unruptured vs. acutely ruptured aneurysms, and with vs. without pre-medication. Statistical significance was reached in eight tests.


CONCLUSIONS
Intracranial stent is a safe and effective tool for embolizing complex intracranial aneurysms. Self-expandable stents are significantly easier and safer than balloon-expandable stents with respect to navigation and deployment through the tortuous cerebral vasculature. Patients with acutely ruptured aneurysms are more likely to be dependent, but not more likely to suffer more procedure-related complications.
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
Peng-Fei
PF
Yang
Qing-Hai
QH
Huang
Wen-Yuan
WY
Zhao
Bo
B
Hong
Yi
Y
Xu
Jian-Min
JM
Liu
D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D015607:Stents / Q000009:adverse effects*