Unit:
Speciality Endovascular TechniquesLibrary of the School of Health Sciences
Author:
Papadopoulos Filippos
Supervisors info:
Γεώργιος Γερουλάκος, Καθηγητής, Ιατρική, ΕΚΠΑ
Ιωάννης Κακίσης, Καθηγητής, Ιατρική, ΕΚΠΑ
Αχιλλέας Χατζηϊωάννου, Καθηγητής, Ιατρική, ΕΚΠΑ
Original Title:
Stent assisted coiling of unruptured intracranial aneurysms with wide neck
Translated title:
Stent assisted coiling of unruptured intracranial aneurysms with wide neck
Summary:
Objective: Incidence of cerebral aneurysms is difficult to be estimated. Range of autopsy prevalence of aneurysms is 0,2-7,9%.Recent studies indicate prevalence of 5%. Their intraoperative rupture rate (40%) is associated with high morbidity and mortality rate which is 30-35%. Nowadays, endovascular techniques, mainly coil embolization and stents in conjunction with coils are highly used. We conducted a systematic review and meta-analysis to investigate the role of stent assisted coiling for unruptured intracranial aneurysms with wide neck.
Methods: The current meta-analysis was conducted using the Preferred Reporting items for Systematic Review and meta-analyses guidelines. We investigated patients’ baseline characteristics along with periprocedural and postprocedural outcomes after stent assisted coiling limited to unruptured intracranial aneurysms with wide neck. In this review 13 studies were included and pooled proportions with 95% confidence intervals (CLs) of outcome rates were calculated.
Results: The included studies were published from 2005-2017. Among 976 patients with a mean age of 50 years included in our systemic review 384 were female (72,6%).For another 447 patients’ gender is not specified. The device was usually delivered though femoral artery (the access vessel was noted in 466 of 976 patients) and the procedure took place under general anesthesia in nearly half of the patients. Technical success of the method was 98.43 % (95% CI: 95.62-99.95). Immediate outcomes included total obliteration- periprocedural with 50.20% (95% CI: 36.09-64.30) and rupture- periprocedural with 0.00% (95% CI: 0.00-0.43). The median follow-up ranged from 6 months to 2 years showed that total postprocedural obliteration was 63.83% (95% CI: 45.80-80.18) and overall late rupture was 0.41% (95% CI: 0.00-2.38). The pooled in-stent stenosis rate was 1.24% (95% CI: 0.02-3.63). We also estimated a pooled rate of 0.02% (95% CI: 0,00-0,51) and 4.33% (95% CI: 2.03-7.23) for total mortality and overall neurological complications respectively as well as 3.94% (95% CI: 1.48-7.33) for stroke. Finally, recanalization was recorded in 7.07% (95% CI: 4.35-10.26).
Conclusions: Stent assisted coiling of unruptured intracranial aneurysms with wide neck seems to be safe and an acceptable alternative to surgical clipping. Even if immediate anatomical results are relatively unsatisfying in our study, mid- and long-term follow-up show a major improvement with a high rate of adequate occlusion that is stable over time.
Main subject category:
Health Sciences
Keywords:
Stent-Assisted, Coiling, Intracranial Aneurysms, Wide Neck
