Background and Purpose Stent-assisted coiling was initially invented for wide-neck aneurysms, but is now used for smaller berry aneurysms. The aim of this study was to compare the safety and efficiency of stent-assisted coiling with conventional coiling in treatment of intracranial aneurysms. Methods A meta-analysis of studies that compared stent-assisted coiling with coiling only was conducted by searching English literatures via Pubmed, Medline and Cochrane Library databases without restricting the publication year. The primary outcomes in this study were immediate occlusion, progressive thrombosis rate, all-complication rate and angiographic recurrence. The secondary outcomes examined were packing density, mortality, permanent complication and thromboembolic complication rate. Results Ten retrospective cohort studies were included. There is currently only one unfinished randomized study. Although the stent-assisted coiling group tended to show a lower initial occlusion rate than that of the coiling-only group (57.6% versus 68.7%; OR, 0.66; 95% CI, 0.30–1.44; P = 0.30), it achieved a significantly higher progressive thrombosis rate during follow up compared to that of the coiling only group (37.5% versus 19.4%; OR, 2.75; 95% CI, 1.95–3.86; P<0.00001) and a significantly lower recurrence rate (16.2% versus 34.4%; OR, 0.35; 95% CI, 0.25–0.49; P<0.00001). With respect to safety concerns, the all-complication rate (17.6% versus 15.9%; OR, 1.12; 95% CI, 0.77–1.62; P = 0.56), mortality rate (9.1% versus 2.6%; OR, 2.31; 95% CI, 0.68–7.82; P = 0.18), permanent complication rate (5.6% versus 3.9%; OR, 1.52; 95% CI, 0.96–2.41; P = 0.08) and thromboembolic complication rate (4.2% versus 4.9%; OR, 0.99; 95% CI, 0.41–2.38; P = 0.97) did not show significant difference between the two groups. Conclusions Stent-assisted coiling has a lower recurrence rate than conventional coiling. Analysis of complication events did not show any significant difference between the two methods. Despite the findings reported herein, further validation by well-designed prospective studies is needed.
References
[1]
Li H, Pan R, Wang H, Rong X, Yin Z, et al. (2013) Clipping versus coiling for ruptured intracranial aneurysms: a systematic review and meta-analysis. Stroke 44: 29–37.
[2]
Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, et al. (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34: 1398–1403.
[3]
Benitez RP, Silva MT, Klem J, Veznedaroglu E, Rosenwasser RH (2004) Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery 54: 1359–1367; discussion 1368.
[4]
Biondi A, Janardhan V, Katz JM, Salvaggio K, Riina HA, et al.. (2007) Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery 61: 460–468; discussion 468–469.
[5]
Higashida RT, Smith W, Gress D, Urwin R, Dowd CF, et al. (1997) Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. J Neurosurg 87: 944–949.
[6]
Piotin M, Blanc R, Spelle L, Mounayer C, Piantino R, et al. (2010) Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke; a journal of cerebral circulation 41: 110–115.
[7]
Koebbe CJ, Veznedaroglu E, Jabbour P, Rosenwasser RH (2006) Endovascular management of intracranial aneurysms: current experience and future advances. Neurosurgery 59: S93–102; discussion S103–113.
[8]
Albuquerque FC, Gonzalez LF, Hu YC, Newman CB, McDougall CG (2011) Transcirculation endovascular treatment of complex cerebral aneurysms: technical considerations and preliminary results. Neurosurgery 68: 820–829; discussion 829–830.
[9]
Chalouhi N, Jabbour P, Gonzalez LF, Dumont AS, Rosenwasser R, et al. (2012) Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance: a review of 235 cases. Neurosurgery 71: 785–794.
[10]
Colby GP, Paul AR, Radvany MG, Gandhi D, Gailloud P, et al. (2012) A single center comparison of coiling versus stent assisted coiling in 90 consecutive paraophthalmic region aneurysms. J Neurointerv Surg 4: 116–120.
[11]
Gordhan A, Invergo D (2011) Stent-assisted aneurysm coil embolization: safety and efficacy at a low-volume center. Neurol Res 33: 942–946.
[12]
Izar B, Rai A, Raghuram K, Rotruck J, Carpenter J (2011) Comparison of devices used for stent-assisted coiling of intracranial aneurysms. PLoS One 6: e24875.
[13]
Jahshan S, Abla AA, Natarajan SK, Drummond PS, Kan P, et al. (2013) Results of Stent-Assisted vs Non-Stent-Assisted Endovascular Therapies in 489 Cerebral Aneurysms: Single-Center Experience. Neurosurgery 72: 232–239.
[14]
Kim DJ, Suh SH, Lee JW, Kim BM, Huh SK, et al. (2010) Influences of stents on the outcome of coil embolized intracranial aneurysms: comparison between a stent-remodeled and non-remodeled treatment. Acta Neurochir (Wien) 152: 423–429.
[15]
Kung DK, Policeni BA, Capuano AW, Rossen JD, Jabbour PM, et al. (2011) Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling. Journal of neurosurgery 114: 1021–1027.
[16]
Ogilvy CS, Natarajan SK, Jahshan S, Karmon Y, Yang X, et al. (2011) Stent-assisted coiling of paraclinoid aneurysms: risks and effectiveness. Journal of neurointerventional surgery 3: 14–20.
[17]
Shapiro M, Becske T, Sahlein D, Babb J, Nelson PK (2012) Stent-supported aneurysm coiling: a literature survey of treatment and follow-up. AJNR American journal of neuroradiology 33: 159–163.
[18]
Bodily KD, Cloft HJ, Lanzino G, Fiorella DJ, White PM, et al. (2011) Stent-assisted coiling in acutely ruptured intracranial aneurysms: a qualitative, systematic review of the literature. AJNR Am J Neuroradiol 32: 1232–1236.
[19]
Raymond J, Roy D, Leblanc P, Roorda S, Janicki C, et al. (2003) Endovascular treatment of intracranial aneurysms with radioactive coils: initial clinical experience. Stroke 34: 2801–2806.
[20]
Kole MK, Pelz DM, Kalapos P, Lee DH, Gulka IB, et al. (2005) Endovascular coil embolization of intracranial aneurysms: important factors related to rates and outcomes of incomplete occlusion. J Neurosurg 102: 607–615.
[21]
Darsaut TE, Raymond J (2012) The design of the STenting in Aneurysm Treatments (STAT) trial. J Neurointerv Surg 4: 178–181.
[22]
Lawson MF, Newman WC, Chi YY, Mocco JD, Hoh BL (2011) Stent-associated flow remodeling causes further occlusion of incompletely coiled aneurysms. Neurosurgery 69: 598–603; discussion 603–594.
[23]
Fiorella D, Albuquerque FC, Deshmukh VR, McDougall CG (2005) Usefulness of the Neuroform stent for the treatment of cerebral aneurysms: results at initial (3-6-mo) follow-up. Neurosurgery 56: 1191–1201; discussion 1201–1192.
[24]
Lanzino G, Kanaan Y, Perrini P, Dayoub H, Fraser K (2005) Emerging concepts in the treatment of intracranial aneurysms: stents, coated coils, and liquid embolic agents. Neurosurgery 57: 449–459; discussion 449–459.
[25]
Akbari SH, Reynolds MR, Kadkhodayan Y, Cross DT 3rd, Moran CJ (2012) Hemorrhagic complications after prasugrel (Effient) therapy for vascular neurointerventional procedures. J Neurointerv Surg.
[26]
Zhu YQ, Li MH, Fang C, Tan HQ, Wang W, et al. (2010) Application of the Willis covered stent in the treatment of aneurysm in the cisternal segment of the internal carotid artery: a pilot comparative study with midterm follow-up. J Endovasc Ther 17: 55–65.
[27]
Raymond J, Darsaut TE, Bing F, Makoyeva A, Kotowski M, et al. (2013) Stent-assisted coiling of bifurcation aneurysms may improve endovascular treatment: a critical evaluation in an experimental model. AJNR Am J Neuroradiol 34: 570–576.
[28]
Li MH, Gao BL, Fang C, Gu BX, Cheng YS, et al. (2006) Angiographic follow-up of cerebral aneurysms treated with Guglielmi detachable coils: an analysis of 162 cases with 173 aneurysms. AJNR Am J Neuroradiol 27: 1107–1112.
[29]
Kawanabe Y, Sadato A, Taki W, Hashimoto N (2001) Endovascular occlusion of intracranial aneurysms with Guglielmi detachable coils: correlation between coil packing density and coil compaction. Acta Neurochir (Wien) 143: 451–455.
[30]
Sluzewski M, van Rooij WJ, Slob MJ, Bescos JO, Slump CH, et al. (2004) Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. Radiology 231: 653–658.
[31]
Tateshima S, Tanishita K, Hakata Y, Tanoue SY, Vinuela F (2009) Alteration of intraaneurysmal hemodynamics by placement of a self-expandable stent. Laboratory investigation. J Neurosurg 111: 22–27.
[32]
Tahtinen OI, Vanninen RL, Manninen HI, Rautio R, Haapanen A, et al. (2009) Wide-necked intracranial aneurysms: treatment with stent-assisted coil embolization during acute (<72 hours) subarachnoid hemorrhage--experience in 61 consecutive patients. Radiology 253: 199–208.
[33]
Mocco J, Fargen KM, Albuquerque FC, Bendok BR, Boulos AS, et al.. (2011) Delayed thrombosis or stenosis following enterprise-assisted stent-coiling: is it safe? Midterm results of the interstate collaboration of enterprise stent coiling. Neurosurgery 69: 908–913; discussion 913–904.
[34]
Yahia AM, Gordon V, Whapham J, Malek A, Steel J, et al. (2008) Complications of Neuroform stent in endovascular treatment of intracranial aneurysms. Neurocrit Care 8: 19–30.
[35]
Prabhakaran S, Wells KR, Lee VH, Flaherty CA, Lopes DK (2008) Prevalence and risk factors for aspirin and clopidogrel resistance in cerebrovascular stenting. AJNR Am J Neuroradiol 29: 281–285.
[36]
Reavey-Cantwell JF, Fox WC, Reichwage BD, Fautheree GL, Velat GJ, et al.. (2009) Factors associated with aspirin resistance in patients premedicated with aspirin and clopidogrel for endovascular neurosurgery. Neurosurgery 64: 890–895; discussion 895–896.
[37]
Yahia AM, Latorre J, Gordon V, Whapham J, Malek A, et al. (2010) Thromboembolic events associated with Neuroform stent in endovascular treatment of intracranial aneurysms. J Neuroimaging 20: 113–117.
[38]
Lee DH, Arat A, Morsi H, Shaltoni H, Harris JR, et al. (2008) Dual antiplatelet therapy monitoring for neurointerventional procedures using a point-of-care platelet function test: a single-center experience. AJNR Am J Neuroradiol 29: 1389–1394.
