Staged stenting strategy of acutely wide-neck ruptured intracranial aneurysms: A meta-analysis and systematic review

Yanpeng Wei; Xiaoxi Zhang; Renkun Zhang; Guanghao Zhang; Chenghao Shang; Rundong Chen; Dan Li; Meihua Huyan; Congyan Wu; Kang Zong; Zhengzhe Feng; Dongwei Dai; Qiang Li; Qinghai Huang; Yi Xu; Pengfei Yang; Rui Zhao; Qiao Zuo; Jianmin Liu

doi:10.3389/fneur.2023.1070847

Staged stenting strategy of acutely wide-neck ruptured intracranial aneurysms: A meta-analysis and systematic review

Front Neurol. 2023 Feb 3:14:1070847. doi: 10.3389/fneur.2023.1070847. eCollection 2023.

Authors

Yanpeng Wei¹, Xiaoxi Zhang¹, Renkun Zhang¹, Guanghao Zhang¹, Chenghao Shang¹, Rundong Chen¹, Dan Li¹, Meihua Huyan¹, Congyan Wu¹, Kang Zong¹, Zhengzhe Feng¹, Dongwei Dai¹, Qiang Li¹, Qinghai Huang¹, Yi Xu¹, Pengfei Yang¹, Rui Zhao¹, Qiao Zuo¹, Jianmin Liu¹

Affiliation

¹ Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.

Abstract

Objective: In the study, we explored the safety and effectiveness of staged stenting strategy for acutely wide-neck ruptured intracranial aneurysms.

Methods: Online databases, including PubMed, EMBASE, the Cochrane database, and Web of Science, were retrospectively and systematically searched. The main observation indicators were the procedure-related complication rate, complete occlusion rate, and favorable clinical outcome. Meta-analysis was performed using a random or fixed effect model based on heterogeneity.

Results: A total of 5 studies with 143 patients were included. The hemorrhagic complication rate of the initial coiling and staged stenting was 2.8% (4 of 143) and 0, respectively. The ischemic complication rate of the coiling and supplemental stenting was 3.5% (5 of 143) and 2.9% (4 of 139), respectively. There were no deaths due to procedure-related complications in two stages. The aneurysm complete occlusion rate was 25% (95% CI, 0.13-0.03; I² = 4.4%; P = 0.168) after initial coiling, 54% (95% CI, 0.63-0.64; I² = 0%; P = 0.872) after staged stenting, and 74% (95% CI, 0.66-0.81; I² = 56.4%; P = 0.562) at follow-up, respectively. Favorable clinical outcome rate 74% (95% CI, 0.61-0.86; I² = 50.5%; P = 0.133) after discharge of initial coiling treatment, and 86% (95% CI, 0.80-0.92; I² = 0; P = 0.410) after discharge from stenting, and 97% (95% CI, 0.93-1.01; I² = 43.8%; P = 0.130) at follow-up.

Conclusion: Staged stenting treatment of wide-neck RIA with coiling in the acute phase followed by delayed regular stent or flow-diverter stent had high aneurysm occlusion rate, favorable clinical outcome rate and low procedure-related complication rate. A more dedicated and well-designed controlled study is warranted for further evaluation of staged stenting treatment compared to SCA in wide-neck RIA.

Keywords: complications; initial coiling; ruptured intracranial aneurysms (RIA); staged stenting; wide-neck.

Publication types

Systematic Review

Grants and funding

The present study was supported by the Changhai Hospital of the Naval Medical University “234 Discipline Climbing Plan” (2020YXK060) and Project from Shanghai Science and Technology Commission (19DZ1930302).