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Stent assisted coiling versus non-stent assisted coiling for the management of ruptured intracranial aneurysms: a meta-analysis and systematic review
  1. Xiaoxi Zhang,
  2. Qiao Zuo,
  3. Haishuang Tang,
  4. Gaici Xue,
  5. Pengfei Yang,
  6. Rui Zhao,
  7. Qiang Li,
  8. Yibin Fang,
  9. Yi Xu,
  10. Bo Hong,
  11. Qinghai Huang,
  12. Jianmin Liu
  1. Department of Neurosurgery, Changhai Hospital, Naval Medical University, Shanghai, China
  1. Correspondence to Professor Jianmin Liu, Department of Neurosurgery, Changhai Hospital, Naval Medical University, Shanghai 200433, China; chstroke{at}163.com

Abstract

Purpose To compare the safety and efficiency of stent assisted coiling (SAC) with non-SAC for the management of ruptured intracranial aneurysms.

Methods A meta-analysis that compared SAC with coiling alone and balloon assisted coiling was conducted by database searching. The primary outcomes of this study were immediate occlusion and progressive thrombosis rate, overall perioperative complication rate, and angiographic recurrence. Secondary outcomes included mortality at discharge, hemorrhagic and ischemic complications, and favorable clinical outcome at discharge and at follow-up.

Results Eight retrospective cohort studies with 1408 ruptured intracranial aneurysms (SAC=499; non-SAC=909) were included. The SAC group tended to show a lower immediate complete occlusion rate than the non-SAC group (54.3% vs 64.2%; RR 0.90; 95% CI 0.83 to 0.99; I2=17.4%) and achieved a significantly higher progressive complete rate at follow-up (73.4% vs 61.0%; RR 1.30; 95% CI 1.16 to 1.46; I2=40.5%) and a lower recurrence rate (4.8% vs 16.6%; RR 0.28; 95% CI 0.16 to 0.50; I2=0.0%). With respect to safety concerns, overall perioperative complications in the SAC group were significantly higher (20.2% vs 13.1%; RR 1.70; 95% CI 1.36 to 2.11; I2=0.0%). However, no significant difference was found for mortality rate at discharge (6.3% vs 6.2%; RR 1.29; 95% CI 0.86 to 1.94; I2=0.0%), or favorable clinical outcome rate at discharge (73.4% vs 74.2%; RR 0.95; 95% CI 0.88 to 1.02; I2=12.1%) and at follow-up (85.6% vs 87.9%; RR 0.98; 95% CI 0.93 to 1.02; I2=0.0%; P=0.338).

Conclusions SAC has a lower recurrence rate than non-SAC. Nevertheless, further validation by well designed prospective studies is warranted for determining whether stents improve angiographic outcome without an increased complication rate or unfavorable clinical outcome.

  • aneurysm
  • balloon
  • stent
  • subarachnoid
  • hemorrhage
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Footnotes

  • XZ, QZ and HT contributed equally.

  • Contributors Conception and design, acquisition of the data, and analysis and Interpretation of the data: XZ, QZ, and HT. Drafting the article: XZ, QZ , andJL. Critically revising the article: XZ, QZ, QH, and JL. All authors reviewed the submitted version of the manuscript and approved the final version of the manuscript. Statistical analysis: XZ, QZ, and HT. Study supervision: QH and JL.

  • Funding This work was supported by the National Key R&D Program of China, grant No 2016YFC1300700, and National Natural Science Foundation of China, grant No 81701136.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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