title: Complications in Stent-Assisted Endovascular Therapy of Ruptured Intracranial Aneurysms and Relevance to Antiplatelet Administration: A Systematic Review.
abstract: OBJECTIVE
  Despite the increasing use of stent-assisted coiling for ruptured intracranial aneurysms, there is little consensus regarding the appropriate antiplatelet administration for this. The objectives of this systematic review were to provide an overview of complications and their association with the method of antiplatelet administration in stent-assisted coiling for ruptured intracranial aneurysms.
  
  
  METHODS
  A comprehensive search of the literature in the data bases was conducted to identify studies reporting complications of stent-assisted coiling for ruptured intracranial aneurysms. The pooled event rate of preprocedural thromboembolisms, hemorrhages, and mortality was estimated from the selected studies. Subgroup analyses were performed by the method of antiplatelet administration (pre-, postprocedural, and modified). Meta-analysis was conducted to compare periprocedural complications and mortality between ruptured intracranial aneurysms and unruptured intracranial aneurysms.
  
  
  RESULTS
  Of the 8476 studies identified, 33 with 1090 patients were included. The event rates of thromboembolism and intra- and postprocedural hemorrhage were 11.2% (95% CI, 9.2%-13.6%), 5.4% (95% CI, 4.1%-7.2%), and 3.6% (95% CI, 2.6%-5.1%), respectively. Subgroup analyses of thromboembolism showed a statistically significant difference between groups (P < .05). In the preprocedural and modified antiplatelet groups, the risk for thromboembolism in stent-assisted coiling for ruptured intracranial aneurysm was not significantly different from that for unruptured intracranial aneurysm, though this risk of the postprocedural antiplatelet group was significantly higher in ruptured intracranial aneurysms than in unruptured intracranial aneurysms.
  
  
  CONCLUSIONS
  On the basis of current evidence, complications of stent-assisted coiling for ruptured intracranial aneurysm may be affected by the method of antiplatelet administration.
authors.affiliation: From the Departments of Radiology (C.-W.R., S.P.) md.cwryu@gmail.com.
authors.forename: C-W
authors.identifier: http://orcid.org/0000-0002-4674-7295
authors.initials: CW
authors.lastname: Ryu
authors.affiliation: From the Departments of Radiology (C.-W.R., S.P.).
authors.forename: S
authors.initials: S
authors.lastname: Park
authors.affiliation: Neurosurgery (H.S.S., J.S.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Seoul, South Korea.
authors.forename: H S
authors.identifier: http://orcid.org/0000-0002-5286-8448
authors.initials: HS
authors.lastname: Shin
authors.affiliation: Neurosurgery (H.S.S., J.S.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Seoul, South Korea.
authors.forename: J S
authors.initials: JS
authors.lastname: Koh
mesh_terms: D017542:Aneurysm, Ruptured / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation; D057510:Endovascular Procedures / Q000009:adverse effects*; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D015607:Stents / Q000009:adverse effects; D015912:Thrombolytic Therapy / Q000009:adverse effects*