Clinical and Angiographic Outcomes After Stent-Assisted Coiling of Cerebral Aneurysms With Laser-Cut and Braided Stents: A Comparative Analysis of the Literatures

Abstract

Introduction: Stent-assisted coiling (SAC) plays an important role in endovascular treatment of intracranial aneurysms (IAs). This comparative analysis examines the safety and efficacy of SAC in general and compares clinical and angiographic outcomes between laser-cut stents and braided stents.Methods: Relevant English-language studies were identified via a PubMed search for published articles regarding outcomes of SAC using laser-cut stents and braided stents published from 2015 to 2020. Data from 56 studies that met our inclusion criteria were pooled and statistically compared.Results: A total of 4,373 patients harboring with 4,540 IAs were included. Patients were divided into two groups on the basis of stent type: laser-cut stents (2,076 aneurysms in 1991 patients; mean follow-up, 12.99 months) and braided stents (2,464 aneurysms in 2382 patients; mean follow-up, 18.41 months). Overall, the rates of successful stent deployment, thromboembolic events, stent stenosis, periprocedural intracranial hemorrhage, permanent morbidity, mortality, and recanalization were 97.72, 4.72, 2.87, 1.51, 2.14, 1.16, and 6.06%, respectively. Laser-cut stents were associated with a significantly higher rate of successful deployment (p = 0.003) and significantly lower rate of periprocedural intracranial hemorrhage (p = 0.048). Braided stents were associated with a significantly lower rate of permanent morbidity (p = 0.015).Conclusion: SAC of IAs using laser-cut stents or braided stents was effective and safe. Rates of thromboembolic events, stent stenosis, mortality, and recanalization were comparable between the stent types. Braided stents were associated with lower permanent morbidity while laser-cut stents were associated with more favorable rates of successful deployment and periprocedural intracranial hemorrhage.

Procedural Outcome Following Stent-Assisted Coiling for Wide-Necked Aneurysms Using Three Different Stent Models: A Single-Center Experience

“…Closed-cell stent designs, on the other hand, contain the risk of poor wall apposition and kinking tortious vessel curves. We observed a relatively high rate of complete aneurysm obliteration (RROC I) of 78% in the whole study cohort, which is in line with previous studies investigating SACs ranging from 54–81% with different stent models [ 4 , 5 , 19 , 20 , 21 ]. In our study the rate did not differ between different stent models but was numerically higher in the closed-cell LEO+™ stent group.…”

“…Additionally, balloon-assisted coiling may have an advantage regarding the control of medical risk factors for periprocedural hemorrhage but increases the weight of ischemic risk factors. Additionally, the rates of ischemic events and intracranial hemorrhage after SAC in the literature differ around 5% and 2%, respectively [ 19 ]. In our case series, we observed low rates of hemorrhagic and ischemic events, highlighting the general safety of the procedure.…”

Stent-assisted coiling vs. coiling alone of ruptured tiny intracranial aneurysms: A contemporary cohort study in a high-volume center

“…The performance of each stent type depends on structures or manufacturing processes, showing different behaviors in delivery method, neck protection, and flow diversion. When it comes to the SAC group, various clinical and angiographic outcomes in braided and laser-cut SAC for intracranial aneurysms have been observed in several studies ( 12 , 25 , 26 ). Nevertheless, the performance of these two stent types in terms of perioperative procedure-related complications is still controversial.…”

“…The low-profile visualized intraluminal support improves flow diversion effect and promotes reendothelialization due to its higher metal coverage (23%) and smaller mesh (1 mm) compared with laser-cut stents, theoretically, which could promote delayed aneurysm thrombosis and obtain a favorable occlusion rate in long-term follow-up ( 34 ). Nevertheless, a recent systematic review showed that the follow-up complete occlusion and recurrence in the LVIS group were comparable with the laser-cut group ( P = 0.454, 0.056, respectively) ( 26 ). Lim et al ( 35 ) reported a cohort study and demonstrated similar outcomes in follow-up and recurrence rates between the LVIS group and the Enterprise group.…”

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

“…A comprehensive meta-analysis stated that SAC using braided stents had initial and last follow-up favorable aneurysm occlusion rates of 85.5% and 91.9%, respectively. 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.…”