Stent-Assisted Coiling versus Coiling in Treatment of Intracranial Aneurysm: A Systematic Review and Meta-Analysis

Abstract

Background and PurposeStent-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.MethodsA 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.ResultsTen 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.ConclusionsStent-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.

Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis

“…72 Procedurerelated complications were comparable in the SAC group and the coiling-alone group. 34 Delayed (30-day) ISS or occlusion following SAC was reported to be 3.4%-5.8%. 26,50 At present, the time frame for complete occlusion of an aneurysm is unknown.…”

Risk Factors for Hemorrhagic Complications following Pipeline Embolization Device Treatment of Intracranial Aneurysms: Results from the International Retrospective Study of the Pipeline Embolization Device

“…[20][21][22] Typically, intracranial stent placement requires dual antiplatelet therapy for at least 3 months, similar to PED use, so the increased number of reported IPHs among PED patients relative to stentcoil patients suggests an innate increase in the incidence with PEDs. One may speculate that the increased metal surface area to which the platelets are exposed may result in activation through increased shear, despite antiplatelet therapy.…”

Hydrogel versus Bare Platinum Coils in Patients with Large or Recurrent Aneurysms Prone to Recurrence after Endovascular Treatment: A Randomized Controlled Trial

“…[10][11][12][13] A randomized trial comparing hydrogel and platinum coiling published in 2011 failed to confirm its primary composite endpoint in favor of hydrogel coils but demonstrated improved core laboratory adjudicated angiographic outcomes overall and in prespecified subgroups of medium (5.0 -9.0 mm) and ruptured aneurysms. 11,14 There was no difference in retreatment rates.…”

“…4 Although meta-analyses of case series have reported improved angiographic results with stent-assisted coiling 12 or flow diversion 10 compared with historical coiling controls, preliminary results from the Flow Diversion in Intracranial Aneurysm Treatment trial have so far been below expectations.…”