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


CONCLUSIONS
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.
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Ming-Tao
MT
Feng
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Wan-Ling
WL
Wen
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Zheng-Zhe
ZZ
Feng
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Yi-Bin
YB
Fang
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: chstroke@163.com.
Jian-Min
JM
Liu
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: ocinhqh@163.com.
Qing-Hai
QH
Huang
D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data; D015897:Comorbidity; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000706:statistics & numerical data*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control; D016896:Treatment Outcome
Coil; Endovascular; Intracranial aneurysms; Stent; Subarachnoid hemorrhage