Use of stent-assisted coil embolization for the treatment of wide-necked aneurysms: A systematic review

Abstract

Background:The use of stent-assisted coiling (SAC) has been shown to be a treatment option for complex aneurysms. We reviewed systematically the immediate and mid-term angiographic results following treatment of wide-necked aneurysms with self-expanding stents and coils, as well as the peri- and postprocedural rate of complications.Methods:A computerized database search was conducted from 01/2000 to 04/2011 using appropriate indexed terms on Pubmed. Inclusion criteria were: (1) homogeneous populations of ≥10 patients with wide-necked aneurysms; (2) use of a self-expandable neurovascular stent and coils for aneurysm treatment; (3) immediate and follow-up angiographic results; and (4) periprocedural and delayed thrombotic complications.Results:Seventeen studies were included, containing retrospectively collected data on 656 patients/702 aneurysms. The target aneurysm was located on the anterior circulation in 78.4% of patients. The immediate rate of complete occlusion was 46.3%, (19.3-98.1%). The intra- and postprocedural rate of intrastent thrombosis or thromboembolic event was 4.6% and 4.3%, respectively. Complete occlusion was documented in 71.9% at last angiographic follow-up. The rate of recanalization was 13.2% of aneurysms (0-28.8%). Delayed in-stent stenosis occurred in 5.3% cases (0-20.6%).Conclusion:SAC has been considered a treatment option for selected wide-necked aneurysms in some institutions. The use of intracranial stents should take into consideration the risk of ischemic complications, recanalization, delayed in-stent stenosis; and the currently unknown lifetime risks for stenosis, vascular injury, device failure, and aneurysm recurrence related to intracranial stenting. There is an evident need for a prospective multicenter registry for all treated patients with SAC.

Long-term angiographic outcome of stent-assisted coiling compared to non-assisted coiling of intracranial saccular aneurysms

“…It must be noted that despite the improvement of angiographic outcome in SAC group, almost half of aneurysms in both groups were still incompletely occluded with persisting risk of rupture. Our rate of complete aneurysm occlusion (56.2% in SAC group and 50.5% in NAC group) was lower than a previously published rate (61%-71.9% for SAC and 61.5% for NAC) ( 27 - 29 ), but this did not lead to an increased rate of delayed rupture or re-rupture (0.9% of all coiled aneurysms in our institution).…”

Predictors of treatment failure following coil embolization of intracranial aneurysms

“…Some studies have suggested the SAC results in improved outcomes [35][36][37] while some have found similar results to stand-alone coiling [38][39][40][41]. A systematic review of multiple studies found the recanalization rate to be 13.2% following SAC [42], which is lower than the 20% reported for stand-alone coiling. Lawson et al found that SAC not only had improved recurrence rates but also promoted progressive thrombosis [43].…”

Intracranial aneurysm with neck indistinguishable from surrounding artery branches by cerebral angiography

“…Interventional treatment has gradually become an important method of aneurysm management and virtually almost 100% of aneurysms have been occluded by embolization in recent years [5]. However, with regard to widenecked and large aneurysms, current technical limitations in embolization technology have prevented complete and durable aneurysm occlusion [6]. It is generally believed that contraindications of embolization include the following: aneurysm is too small in size (<2 mm); intubation artery is with severe hardening distortions or Figure 2.…”