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      Treatment of Intracranial Aneurysms with Self-Expandable Braided Stents: A Systematic Review and Meta-Analysis

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          Abstract

          BACKGROUND:

          The safety and efficacy of treatment with self-expandable braided stents (LEO and LVIS) required further investigation.

          PURPOSE:

          Our aim was to analyze the outcomes after treatment with braided stents.

          DATA SOURCES:

          A systematic search of 3 databases was performed for studies published from 2006 to 2017.

          STUDY SELECTION:

          According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting patients treated with LEO or LVIS stents.

          DATA ANALYSIS:

          Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and neurologic outcomes.

          DATA SYNTHESIS:

          Thirty-five studies evaluating 1426 patients treated with braided stents were included in this meta-analysis. Successful stent delivery and complete aneurysm occlusion were 97% (1041/1095; 95% CI, 95%–98%) (I 2 = 44%) and 88.3% (1097/1256; 95% CI, 85%–91%) (I 2 = 72%), respectively. Overall, treatment-related complications were 7.4% (107/1317; 95% CI, 5%–9%) (I 2 = 44%). Ischemic/thromboembolic events (48/1324 = 2.4%; 95% CI, 1.5%–3.4%) (I 2 = 27%) and in-stent thrombosis (35/1324 = 1.5%; 95% CI, 0.6%–1.7%) (I 2 = 0%) were the most common complications. Treatment-related morbidity was 1.5% (30/1324; 95% CI, 0.9%–2%) and was comparable between the LEO and LVIS groups. Complication rates between the anterior (29/322 = 8.8%; 95% CI, 3.4%–12%) (I 2 = 41%) versus posterior circulation (10/84 = 10.5%; 95% CI, 4%–16%) (I 2 = 0%) and distal (30/303 = 8%; 95% CI, 4.5%–12%) (I 2 = 48%) versus proximal aneurysms (14/153 = 9%; 95% CI, 3%–13%) (I 2 = 46%) were comparable ( P > .05).

          LIMITATIONS:

          Limitations were selection and publication biases.

          CONCLUSIONS:

          In this analysis, treatment with the LEO and LVIS stents was relatively safe and effective. The most common complications were periprocedural thromboembolisms and in-stent thrombosis. The rate of complications was comparable among anterior and posterior circulation aneurysms, as well as for proximal and distally located lesions.

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          Author and article information

          Journal
          AJNR Am J Neuroradiol
          AJNR Am J Neuroradiol
          ajnr
          ajnr
          AJNR
          AJNR: American Journal of Neuroradiology
          American Society of Neuroradiology
          0195-6108
          1936-959X
          November 2018
          : 39
          : 11
          : 2064-2069
          Affiliations
          aFrom the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
          bDepartment of Neurosurgery (D.d.C., P.P.), University of Pisa, Pisa, Italy
          cSection of Statistics (R.M., V.M.), University Hospital of Pisa, Pisa, Italy
          dNeuroradiology Department (D.M.), Clinic FOSCAL, Universidad Autonoma de Bucaramanga, Andrés Bello National University, Santiago, Chili
          Author notes
          Please address correspondence to Federico Cagnazzo, MD, Neuroradiology Department, CHU Güi De Chauliac, 80 Ave Augustin Fliche, 34000 Montpellier, France; e-mail: f.cagnazzo86@ 123456gmail.com
          Article
          PMC7655354 PMC7655354 7655354 18-00280
          10.3174/ajnr.A5804
          7655354
          30262643
          © 2018 by American Journal of Neuroradiology
          Categories
          Interventional

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