Stent assisted coiling versus non-stent assisted coiling for the management of ruptured intracranial aneurysms: a meta-analysis and systematic review

Zhang, Xiaoxi; Zuo, Qiao; Tang, Haishuang; Xue, Gaici; Yang, Pengfei; Zhao, Rui; Li, Qiang; Fang, Yibin; Xu, Yi; Hong, Bo; Huang, Qinghai; Liu, Jianmin

doi:10.1136/neurintsurg-2018-014388

Cited by 76 publications

(58 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With stent-assisted coiling and anticoagulation, complications are higher than with simple coiling with more hemorrhagic and ischemic complications and higher mortality, especially in ruptured aneurysms. [26][27][28][29][30] Even though anti-platelet medication is not recommended for WEB treatment, in this review anti-coagulation protocol varied widely between studies and between ruptured versus unruptured aneurysms. Most operators used periprocedural single or dual antiplatelet therapy in unruptured aneurysms as a preventive measure with the possible use of a stent as a bailout for protrusion of the WEB over the parent vessel.…”

Section: Discussionmentioning

confidence: 99%

“…Mid-term occlusion rates are in the same range as for stent-assisted coiling, and complication rates tend to be lower, especially in ruptured aneurysms since the antiplatelet medication is not needed. [26][27][28][29][30] The imperative use of dual antiplatelet medication with the use of stents or extra-saccular flow diverters 31 imposes patients with ruptured aneurysms to a significant risk of rebleed and other hemorrhagic complications.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A systematic review and meta-analysis of Woven EndoBridge single layer for treatment of intracranial aneurysms

et al. 2020

View full text Add to dashboard Cite

Background and purpose The Woven EndoBridge is an intrasaccular device for the treatment of intracranial aneurysms. The first generation consisted of a high-profile double-layer braid. This review aims to evaluate the outcomes of the new generation low-profile Woven EndoBridge single layer device for intracranial aneurysm treatment. Methods A systematic review was conducted with Medline, Embase, and Web of Science Conference Proceedings databases. The search strategy provided 589 articles, 15 articles were included. Results Fifteen articles were identified reporting the use of Woven EndoBridge single-layer devices in 963 aneurysms, mostly wide-necked bifurcation aneurysms. Procedural aneurysm rupture was reported in 8 of 963 patients (0.83%; 95%CI 0.39–1.66%) and thromboembolic events in 54 of 963 patients (5.61%, 95CI 4.31–7.26%). Cumulative morbidity was 2.85% (27/949, 95%CI 1.95–4.12%) and mortality 0.93% (9/963, 95%CI 0.46–1.80%). The overall rate of adequate aneurysm occlusion at last follow-up was 83.3% (613/736; 95%CI 80.4–85.8%). Retreatment was reported in 38 aneurysms in eight studies with 450 aneurysms with follow-up (38/450; 8.4%, 95CI 6.2–11.4%). In 12 studies comprising 644 aneurysms with follow-up, rebleeds occurred in three patients in three studies with mean follow-up between 3.3 and 14.4 months (0.47%, 95%CI 0.09–1.43%) Conclusion Woven EndoBridge single-layer is a promising new low-profile device especially for wide-neck bifurcation aneurysms, both ruptured and unruptured. No antiplatelet medication is needed which is a great advantage, especially in ruptured aneurysms. Efficacy and safety compare favorably with (stent-assisted) coiling. However, no direct comparison with other treatments is available as yet.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of Woven EndoBridge single layer for treatment of intracranial aneurysms

et al. 2020

View full text Add to dashboard Cite

show abstract

“…It is still gradually accepted by neurosurgeons due to its advantages in terms of effectiveness, durability, and facility in treating complex and wide-necked IAs [3,4,26]. SAC can also improve aneurysmal complete occlusion rate, reduce recurrence rate, and decrease incidence of rebleeding or retreat rate [27,28]. Furthermore, SAC brings a comparable complication rate than to NSC [2,17,[26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

The safety and outcomes of acutely ruptured intracranial aneurysms with incomplete occlusion after coiling: a case-control study

et al. 2020

View full text Add to dashboard Cite

Background Incomplete aneurysmal occlusion is a common feature of immediate posttreatment angiography. The safety and outcomes of acutely ruptured intracranial aneurysms (RIAs) with incomplete occlusion after stent-assisted coiling (SAC) and no-stent coiling (NSC) have not been well clarified. Progressive occlusion of stents can promote the complete occlusion of intracranial aneurysms (IAs), but it remains to be determined if progressive occlusion in acutely RIAs with incomplete occlusion after coiling may be enhanced by protective stenting. This study aimed to evaluate the safety and outcomes of those aneurysms after SAC and NSC; And to discover whether the stents can promote progressive aneurysm occlusion in such lesions or not. Methods We reviewed 199 patients with acutely RIAs underwent endovascular coiling and developed incomplete occlusion in the past seven years. The patients’ clinical and imaging information were recorded and analyzed. Univariate and multivariate analyses were performed to determine the association of recurrence rate with potential risk factors. Results SAC group had wider aneurysms neck (3.471 mm vs 2.830 mm, P = 0.009) and smaller dome-to-neck ratio (1.536 vs 2.111, P = 0.001) than in NSC group. There was no significant difference between the two groups in total procedure-related complications rate (31.7% vs 23.5%, P = 0.195), procedure-related mortality (6.9% vs 2.0%, P = 0.170) and modified Rankin Scale (mRS) score at 6-month follow-up (P > 0.05). However, SAC group had significantly higher ischemic complications rate (21.8% vs 8.2%, P = 0.007) and complete occlusion rate (65.6% vs 48.3%, P = 0.020), and lower recurrence rate (15.6% vs 28.1%, P = 0.042) than NSC group based on 6-month follow-up angiograms. Additionally, Multivariable analysis showed NSC was an independent risk factor for aneurysm recurrence (Odds Ratio [OR]: 4.061; P = 0.018). Conclusions Acutely RIAs with incomplete occlusion after SAC is associated with higher complications rate and mortality, but has an acceptable safety profile and similar clinical outcome compared to NSC, as well as gives patients superior angiography outcome by progressive occlusion of stents.

show abstract

“…The recurrence rate may be higher for patients treated with double microcatheter technique than those treated by stent-assisted coiling. The procedure-related complications are about 20% for patients receiving stent-assisted coiling with ruptured aneurysms [21,29]. The data for procedure-related complications in ruptured aneurysms treated by double microcatheter are rare.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Endovascular treatment of ruptured aneurysms in anterior cerebral circulation with double microcatheter technique

Zhao¹,

Liu²,

Wang³

et al. 2020

Preprint

View full text Add to dashboard Cite

Purpose Single coiling may be the optimal strategy for ruptured aneurysms. But assisted techniques may be needed in some aneurysms. The authors report their experience of double microcatheter technique in the treatment of ruptured aneurysms in anterior cerebral circulation. Methods Between 2012 and 2018, 82 patients with ruptured aneurysms in anterior cerebral circulation were treated with double microcatheter technique. The clinical records, angiographic results, procedure-related complications were reviewed. Clinical and angiographic follow-up was performed. Results Completely occlusion, neck remnant and partial occlusion were achieved in 56.6%, 36.1% and 7.2% in the whole procedures, respectively. The overall rate of morbidity was 8.5% (7/82). The rate of permanent morbidity was 3.7% (3/82). Three patients (3.7%) died before discharge. There was no procedure-related mortality. The favorable outcomes were obtained in 75.6% (62/82) of the whole patients at discharge. High Hunt-Hess grade and suffering from craniotomy or EVD were risk factors for clinical outcomes at discharge. Sixty-eight patients received clinical follow-up at a mean interval of 15.75±12.71 months. Favorable outcomes were obtained in 61 (89.7%) patients. Angiographic follow-up was performed in 44 patients at an average of 13.16±13.12 months. The recurrence rate is 34.1%. Seven of them (15.9%) received retreatment. Conclusion Double microcatheter technique is a safe and effective method for treatment of ruptured aneurysms in anterior cerebral aneurysms with low morbidity. Recurrence remains a problem. Patients should be followed up regularly.

show abstract

Stent assisted coiling versus non-stent assisted coiling for the management of ruptured intracranial aneurysms: a meta-analysis and systematic review

Cited by 76 publications

References 29 publications

A systematic review and meta-analysis of Woven EndoBridge single layer for treatment of intracranial aneurysms

A systematic review and meta-analysis of Woven EndoBridge single layer for treatment of intracranial aneurysms

The safety and outcomes of acutely ruptured intracranial aneurysms with incomplete occlusion after coiling: a case-control study

Endovascular treatment of ruptured aneurysms in anterior cerebral circulation with double microcatheter technique

Contact Info

Product

Resources

About