Safety of stent-assisted coiling for the treatment of wide-necked ruptured aneurysm: A systematic literature review and meta-analysis of prevalence

Abstract

Background Stent-assisted coil embolization of ruptured wide-necked aneurysms is a controversial treatment modality due to concerns on the peri-procedural safety of anti-platelet therapy in the setting of acute subarachnoid hemorrhage. Our aim was to systematically review the literature on stent-assisted coil embolization of acutely ruptured wide-neck aneurysms to calculate the pooled prevalence of clinical outcome, thromboembolic and hemorrhagic complication rates and overall mortality. Methods We searched PubMed and Google Scholar for articles published between 2009 and 2019 and stratified selected articles based on risk of publication bias. Data on thromboembolic and hemorrhagic complications, clinical outcomes and mortality rates were analyzed using quality-effects model and double arcsine transformation. Results 24 articles were included featuring a total of 1582 patients. Thromboembolic and hemorrhagic complication rates were witnessed in 9.1% [95% CI: 6.0% – 12.7%; I2 = 72.8%] and 8.7% [95% CI: 5.4 – 12.6%; I2 = 77.2%] of patients, respectively. 245 patients received external ventricular drains, of which 33 (13.5%) had EVD-related hemorrhages. Total complication rate was 20.8% [95% CI: 14.2 – 28.1%; I2 = 87.0%]. 57% of aneurysms were completely occluded and a favorable clinical outcome was reported in 74.7% [95% CI: 66.4 – 82.2%; I2 = 86.0] of patients. Overall mortality rate came at 7.8% [95% CI: 4.8 – 11.6%; I2 = 76.9%]. Conclusion Stent-assisted coiling of ruptured intracranial aneurysm is a technically feasible procedure with controlled thromboembolic complication rate but may be associated with higher hemorrhagic and total complication rates compared to coiling alone. While stent-assisted coiling of ruptured wide-necked aneurysm seems to yield a lower rate of favorable clinical outcome, overall mortality is comparable to that of endovascular coiling alone.

Safety and Efficacy of the Woven EndoBridge Device for Treatment of Ruptured Intracranial Aneurysms: A Systematic Review and Meta-analysis

“…Several series have recently been published examining the efficacy of stentassisted coiling in the treatment of ruptured aneurysms. 22 In a recently published meta-analysis by Bsat et al, 22 the rates of postinterventional rebleeding (2.5%) and hemorrhagic complications (8.7%) were higher than the rates of these complications in the setting of WEB device deployment according to our metaanalysis. The risk of thromboembolic complications in the metaanalysis of Bsat et al was 9.1%, and this is also higher than that found in our study (6.8%).…”

Modified balloon-assisted coiling instead of acute stenting in the treatment of ruptured wide necked intracranial aneurysms

“…The SAC technique in EVT of ruptured aneurysms has higher overall perioperative complications than the non-SAC techniques. 14,15 In our study, similar to the literature, we found that SAC for the treatment of ruptured WNAs had the highest complication rates compared to cBAC and mBAC (p < 0.05). The complication rates of SAC, including thromboembolic events, increase up to 10-fold during the acute phase of SAH.…”

“…27 The proportion of patients who underwent SAC for ruptured WNAs and had favorable clinical outcomes were reported as 66-88% in a literature review. 15 In our study, we observed that the angiographic and clinical outcomes in the SAC group were comparable to those in the literature. The favorable angiographic outcomes of the SAC and mBAC techniques were similar at the 6 th -month follow-up (p > 0.05).…”

Predictors of thromboembolic complications after stent-assisted coiling of acutely ruptured intracranial aneurysms: A retrospective multicenter study

“…Our finding is similar to previous studies that showed the incidence of thromboembolic complications was 7.8–15% after SAC of ruptured intracranial aneurysms ( 14 – 17 ). Bsat et al ( 18 ) systematically reviewed the literature on SAC of acutely ruptured aneurysms in 1,582 patients and found that the overall rate of thromboembolic complications was 9.1% (95% CI: 6.0–12.7%; I = 72.8%). There was a high rate of thromboembolic complications, probably because of insufficient coverage of antiplatelet therapy or antiplatelet resistance ( 19 ).…”