Comparison of Stent-Assisted and Non-Stent-Assisted coil embolization in the treatment of Wide-Neck intracranial aneurysms: A Meta-Analysis.

OBJECTIVE

To evaluate the safety and efficacy of stent-assisted coiling (SAC) and non-stent-assisted coiling (NSAC) in the treatment of wide-neck intracranial aneurysms (WNAs).

METHODS

A meta-analysis was conducted to compare SAC and NSAC in treating WNAs. Primary outcomes were aneurysm occlusion rates and perioperative complication rates.

RESULTS

A total of 11 studies were included in this meta-analysis, encompassing 964 patients, with 547 assigned to the SAC group and 417 to the NSAC group. The SAC group demonstrated a significantly higher long-term complete occlusion rate (RR = 1.41, 95% CI [1.18, 1.68], p < 0.001) compared to the NSAC group. Additionally, the aneurysm recurrence rate was significantly lower in the SAC group (RR = 0.41, 95% CI [0.30, 0.56], p < 0.001). However, the SAC group exhibited a significantly higher incidence of ischemic complications (RR = 2.00, 95% CI [1.37, 2.94], p < 0.001), underscoring the increased risks associated with this treatment modality. When comparing the SAC group to the balloon-assisted coiling (BAC) and dual microcatheter coiling (DMC) groups, SAC demonstrated a significant advantage only in terms of recurrence rates: BAC (RR = 0.53, 95% CI [0.30, 0.92], p = 0.025) and DMC (RR = 0.49, 95% CI [0.30, 0.80], p = 0.004). In patients with ruptured aneurysms, the SAC group achieved a significantly higher complete occlusion rate (RR = 1.35, 95% CI [1.15, 1.59], p < 0.001) and a notably lower recurrence rate (RR = 0.29, 95% CI [0.15, 0.56], p < 0.001). Despite these positive outcomes, the overall complication risk (RR = 1.35, 95% CI [1.03, 1.78], p = 0.031) and the risk of ischemic complications (RR = 2.23, 95% CI [1.43, 3.46], p < 0.001) were significantly higher in the SAC group compared to the NSAC group.

CONCLUSIONS

SAC provides superior long-term occlusion rates for RIA but is associated with higher perioperative ischemic complications than NSAC. Although it lowers recurrence compared to BAC and DMC, it may not be suitable for all patients.