Endovascular coiling of wide-neck and wide-neck bifurcation aneurysms

A systematic review and meta-analysis

B. Zhao, R. Yin, G. Lanzino, David F Kallmes, H. J. Cloft, Waleed Brinjikji

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: We present the results of a systematic review and meta-analysis examining outcomes of endovascular coiling of wide-neck and wide-neck bifurcation aneurysms with and without stent assistance. The aim of our study was to assess angiographic and clinical outcomes. MATERIALS AND METHODS: We performed a comprehensive literature search for all articles on the endovascular coiling of wide-neck and wide-neck bifurcation aneurysms. Studies meeting our inclusion criteria and abstracted data were selected by 2 independent reviewers. Primary outcomes were >6-month complete or near-complete angiographic occlusion, aneurysm recanalization, and aneurysm retreatment. Secondary outcomes included initial complete or near-complete occlusion, long-term good neurologic outcome, procedure- related morbidity, and procedure-related mortality. Data were analyzed by using random-effects meta-analysis. RESULTS: In total, 38 studies including 2446 patients with 2556 aneurysms were included. For all wide-neck aneurysms, immediate complete or near-complete occlusion rate was 57.4% (95% CI, 48.1%- 66.8%). Follow-up near-complete occlusion rate was 74.5% (95% CI, 68.0%-81.0%). Recanalization and retreatment rates were 9.4% (95% CI, 7.1%-11.7%) and 5.8% (95% CI, 4.1%-7.5%), respectively. Long-term good neurologic outcome was 91.4% (95% CI, 88.5%-94.2%). For wide-neck bifurcation aneurysms, initial complete or near-complete occlusion rate was 60.0% (95% CI, 42.7%-77.3%), long-term complete or near-complete occlusion rate was 71.9% (95% CI, 52.6%-91.1%), and the recanalization and retreatment rates were 9.8% (95% CI, 7.1%-12.5%) and 5.2% (95% CI, 1.9%- 8.4%), respectively. CONCLUSIONS: Our study of angiographic and clinical outcomes for patients with wide-neck aneurysms demonstrates that endovascular coiling with or without stent-assisted coiling is safe, with low rates of perioperative morbidity and mortality. Initial and long-term angiographic outcomes were generally satisfactory, but not ideal. These data provide some baseline comparisons against which emergent technologies can be assessed.

Original languageEnglish (US)
Pages (from-to)1700-1705
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume37
Issue number9
DOIs
StatePublished - Sep 1 2016

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Aneurysm
Meta-Analysis
Neck
Retreatment
Nervous System
Stents
Morbidity
Mortality
Technology

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Endovascular coiling of wide-neck and wide-neck bifurcation aneurysms : A systematic review and meta-analysis. / Zhao, B.; Yin, R.; Lanzino, G.; Kallmes, David F; Cloft, H. J.; Brinjikji, Waleed.

In: American Journal of Neuroradiology, Vol. 37, No. 9, 01.09.2016, p. 1700-1705.

Research output: Contribution to journalReview article

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abstract = "BACKGROUND AND PURPOSE: We present the results of a systematic review and meta-analysis examining outcomes of endovascular coiling of wide-neck and wide-neck bifurcation aneurysms with and without stent assistance. The aim of our study was to assess angiographic and clinical outcomes. MATERIALS AND METHODS: We performed a comprehensive literature search for all articles on the endovascular coiling of wide-neck and wide-neck bifurcation aneurysms. Studies meeting our inclusion criteria and abstracted data were selected by 2 independent reviewers. Primary outcomes were >6-month complete or near-complete angiographic occlusion, aneurysm recanalization, and aneurysm retreatment. Secondary outcomes included initial complete or near-complete occlusion, long-term good neurologic outcome, procedure- related morbidity, and procedure-related mortality. Data were analyzed by using random-effects meta-analysis. RESULTS: In total, 38 studies including 2446 patients with 2556 aneurysms were included. For all wide-neck aneurysms, immediate complete or near-complete occlusion rate was 57.4{\%} (95{\%} CI, 48.1{\%}- 66.8{\%}). Follow-up near-complete occlusion rate was 74.5{\%} (95{\%} CI, 68.0{\%}-81.0{\%}). Recanalization and retreatment rates were 9.4{\%} (95{\%} CI, 7.1{\%}-11.7{\%}) and 5.8{\%} (95{\%} CI, 4.1{\%}-7.5{\%}), respectively. Long-term good neurologic outcome was 91.4{\%} (95{\%} CI, 88.5{\%}-94.2{\%}). For wide-neck bifurcation aneurysms, initial complete or near-complete occlusion rate was 60.0{\%} (95{\%} CI, 42.7{\%}-77.3{\%}), long-term complete or near-complete occlusion rate was 71.9{\%} (95{\%} CI, 52.6{\%}-91.1{\%}), and the recanalization and retreatment rates were 9.8{\%} (95{\%} CI, 7.1{\%}-12.5{\%}) and 5.2{\%} (95{\%} CI, 1.9{\%}- 8.4{\%}), respectively. CONCLUSIONS: Our study of angiographic and clinical outcomes for patients with wide-neck aneurysms demonstrates that endovascular coiling with or without stent-assisted coiling is safe, with low rates of perioperative morbidity and mortality. Initial and long-term angiographic outcomes were generally satisfactory, but not ideal. These data provide some baseline comparisons against which emergent technologies can be assessed.",
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T2 - A systematic review and meta-analysis

AU - Zhao, B.

AU - Yin, R.

AU - Lanzino, G.

AU - Kallmes, David F

AU - Cloft, H. J.

AU - Brinjikji, Waleed

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N2 - BACKGROUND AND PURPOSE: We present the results of a systematic review and meta-analysis examining outcomes of endovascular coiling of wide-neck and wide-neck bifurcation aneurysms with and without stent assistance. The aim of our study was to assess angiographic and clinical outcomes. MATERIALS AND METHODS: We performed a comprehensive literature search for all articles on the endovascular coiling of wide-neck and wide-neck bifurcation aneurysms. Studies meeting our inclusion criteria and abstracted data were selected by 2 independent reviewers. Primary outcomes were >6-month complete or near-complete angiographic occlusion, aneurysm recanalization, and aneurysm retreatment. Secondary outcomes included initial complete or near-complete occlusion, long-term good neurologic outcome, procedure- related morbidity, and procedure-related mortality. Data were analyzed by using random-effects meta-analysis. RESULTS: In total, 38 studies including 2446 patients with 2556 aneurysms were included. For all wide-neck aneurysms, immediate complete or near-complete occlusion rate was 57.4% (95% CI, 48.1%- 66.8%). Follow-up near-complete occlusion rate was 74.5% (95% CI, 68.0%-81.0%). Recanalization and retreatment rates were 9.4% (95% CI, 7.1%-11.7%) and 5.8% (95% CI, 4.1%-7.5%), respectively. Long-term good neurologic outcome was 91.4% (95% CI, 88.5%-94.2%). For wide-neck bifurcation aneurysms, initial complete or near-complete occlusion rate was 60.0% (95% CI, 42.7%-77.3%), long-term complete or near-complete occlusion rate was 71.9% (95% CI, 52.6%-91.1%), and the recanalization and retreatment rates were 9.8% (95% CI, 7.1%-12.5%) and 5.2% (95% CI, 1.9%- 8.4%), respectively. CONCLUSIONS: Our study of angiographic and clinical outcomes for patients with wide-neck aneurysms demonstrates that endovascular coiling with or without stent-assisted coiling is safe, with low rates of perioperative morbidity and mortality. Initial and long-term angiographic outcomes were generally satisfactory, but not ideal. These data provide some baseline comparisons against which emergent technologies can be assessed.

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