title: Endovascular Coiling of Wide-Neck and Wide-Neck Bifurcation Aneurysms: A Systematic Review and Meta-Analysis.
abstract: We present the results of a systematic review and meta-analysis examining outcomes of endovascular coiling of wide-neck and wide-neck bifurcation aneurysms with and without stent assistance. The aim of our study was to assess angiographic and clinical outcomes.
  
  
  
  We performed a comprehensive literature search for all articles on the endovascular coiling of wide-neck and wide-neck bifurcation aneurysms. Studies meeting our inclusion criteria and abstracted data were selected by 2 independent reviewers. Primary outcomes were >6-month complete or near-complete angiographic occlusion, aneurysm recanalization, and aneurysm retreatment. Secondary outcomes included initial complete or near-complete occlusion, long-term good neurologic outcome, procedure-related morbidity, and procedure-related mortality. Data were analyzed by using random-effects meta-analysis.
  
  
  
  In total, 38 studies including 2446 patients with 2556 aneurysms were included. For all wide-neck aneurysms, immediate complete or near-complete occlusion rate was 57.4% (95% CI, 48.1%-66.8%). Follow-up near-complete occlusion rate was 74.5% (95% CI, 68.0%-81.0%). Recanalization and retreatment rates were 9.4% (95% CI, 7.1%-11.7%) and 5.8% (95% CI, 4.1%-7.5%), respectively. Long-term good neurologic outcome was 91.4% (95% CI, 88.5%-94.2%). For wide-neck bifurcation aneurysms, initial complete or near-complete occlusion rate was 60.0% (95% CI, 42.7%-77.3%), long-term complete or near-complete occlusion rate was 71.9% (95% CI, 52.6%-91.1%), and the recanalization and retreatment rates were 9.8% (95% CI, 7.1%-12.5%) and 5.2% (95% CI, 1.9%-8.4%), respectively.
  
  
  
  Our study of angiographic and clinical outcomes for patients with wide-neck aneurysms demonstrates that endovascular coiling with or without stent-assisted coiling is safe, with low rates of perioperative morbidity and mortality. Initial and long-term angiographic outcomes were generally satisfactory, but not ideal. These data provide some baseline comparisons against which emergent technologies can be assessed.
authors.affiliation: From the Departments of Neurosurgery (B.Z., G.L.).
authors.forename: B
authors.identifier: 0000-0002-5562-0392
authors.initials: B
authors.lastname: Zhao
authors.affiliation: Department of Neurology (R.Y.), The General Hospital of Lanzhou Military Command, Lanzhou, China.
authors.forename: R
authors.identifier: 0000-0001-5006-7172
authors.initials: R
authors.lastname: Yin
authors.affiliation: From the Departments of Neurosurgery (B.Z., G.L.).
authors.forename: G
authors.identifier: 0000-0003-1479-465X
authors.initials: G
authors.lastname: Lanzino
authors.affiliation: Radiology (D.F.K., H.J.C., W.B.), Mayo Clinic, Rochester, Minnesota.
authors.forename: D F
authors.identifier: 0000-0002-8495-0040
authors.initials: DF
authors.lastname: Kallmes
authors.affiliation: Radiology (D.F.K., H.J.C., W.B.), Mayo Clinic, Rochester, Minnesota.
authors.forename: H J
authors.identifier: 0000-0003-2590-3815
authors.initials: HJ
authors.lastname: Cloft
authors.affiliation: Radiology (D.F.K., H.J.C., W.B.), Mayo Clinic, Rochester, Minnesota brinjikji.waleed@mayo.edu.
authors.forename: W
authors.identifier: 0000-0001-5271-5524
authors.initials: W
authors.lastname: Brinjikji
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D038524:Diffusion Magnetic Resonance Imaging; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008670:Metals; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D008670:Metals