Safety and efficacy of stent placement for treatment of intracranial aneurysms: a systematic review

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Objective To evaluate the safety and efficacy of stent placement for the treatment of complex intracranial aneurysms.Data sources We searched six databases,including Pubmed,Embase,SCI-expanded,the Cochrane Library,ISI Proceedings and ProQuest Dissertations & Theses for the relevant studies using multiple key words from December,1997 to February,2009.Study selection Thirty-three studies about stent placement for intracranial aneurysms were identified,which reported data from a total of 1069 patients with 1121 intracranial aneurysms.Data extraction We prepared a standardized data extraction form (DEF),which was used by two independent researchers to extract data from the included 33 studies.Results The overall initial complete occlusion rate was 52.5% (456/869,95% CI:49.2%-55.8%).The overall complication rate was 14.3% (162/1130,95% CI:12.3%-16.4%),of which 3.6% (38/1044,95% CI:2.5%-4.8%) were permanent.Clinical follow-up showed a dependence rate of 8.4% (39/465,95% CI:5.9%-10.9%).Angiographic follow-up showed an improvement rate of 24.3% (117/481,95% CI:20,5%-28.2%) and a recurrence rate of 12.9% (62/481,95% CI:9.9%-15.9%).Chi-squared tests were performed to compare the following subgroups:self-expandable vs.balloon-expandable stents,unruptured vs.acutely ruptured aneurysms,and with vs.without pre-medication.Statistical significance was reached in eight tests.Conclusions Intracranial stent is a safe and effective tool for embolizing complex intracranial aneurysms.Self-expandable stents are significantly easier and safer than balloon-expandable stents with respect to navigation and deployment through the tortuous cerebral vasculature.Patients with acutely ruptured aneurysms are more likely to be deoendent,but not more likely to suffer more procedure-related complications.
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