Sole Stenting versus Stent-Assisted Coiling for Treating Dissecting Posterior Circulation Aneurysms: A Systematic Review and Meta-Analysis

• Published in: World neurosurgery 2024-12, Vol.192, p.201-211.e9
• Main Authors: Prestes, Milena Zadra, Oliveira, Leonardo B., Soares, Cid, Ramos de Souza, Jefferson, Geris da Costa, José, Rabelo, Nicollas Nunes, Batista, Sávio, Bertani, Raphael, Welling, Leonardo C., Pinheiro, Agostinho C., Patel, Nirav J., Figueiredo, Eberval G.
• Format: Article
• Language: English
• Subjects: Aneurysm; Aortic Dissection - surgery; Coil; Dissecting; Embolization, Therapeutic - instrumentation; Embolization, Therapeutic - methods; Endovascular Procedures - instrumentation; Endovascular Procedures - methods; Humans; Intracranial Aneurysm - surgery; Intracranial Aneurysm - therapy; Posterior circulation; Stent; Stents; Treatment Outcome
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.09.020

Among the reconstructive methods for treating dissecting posterior circulation aneurysms, there are stent-assisted coiling (SAC), and sole stenting (SS) therapy. Despite SAC being widely employed when compared to SS, no study systematically analyzed the difference in their outcomes. The authors conducted a meta-analysis of studies employing both therapies to compare their outcomes. A search was performed in January 2024, including only studies with consecutive patients submitted to SS or SAC. The studies had to have at least one of the following outcomes: complete aneurysm occlusion, complications, mortality, aneurysm recurrence, retreatment, and good clinical outcome. Odds ratio (OR) with 95% confidence interval (CI) were utilized for statistics. In a pooled analysis of 17 studies, comparing 173 SS and 377 SAC procedures for dissecting posterior circulation aneurysms, no significant differences were found in related mortality (OR 1.44; 95% CI 0.49–4.27); total mortality (OR 1.33; 95% CI 0.53–3.37); retreatment (OR 0.45; 95% CI 0.16–1.26); recurrence (OR 1.00; 95% CI 0.43–2.33); postoperative complete aneurysmal occlusion (OR 0.79; 95% CI 0.09–6.77); follow-up complete aneurysmal occlusion (OR 1.57; 95% CI 0.62–3.94); intraoperative complications (OR 1.04; 95% CI 0.29–3.73); postoperative complications (OR 1.22; 95% CI 0.61–2.45); hemorrhagic complications (OR 2.16; 95% CI 0.77–6.06); ischemic complications (OR 1.68; 95% CI 0.68–4.15). Good clinical outcomes significantly favored SAC (OR 0.45; 95% CI 0.23–0.86). The findings suggest there is no substantial basis for favoring SAC over SS across all cases. Instead, an individualized approach should be considered, according to the patient's characteristics, surgeon skills, and the available material.