Safety and efficacy of stent placement for treatment of intracranial aneurysms: a systematic review / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of stent placement for the treatment of complex intracranial aneurysms.</p><p><b>DATA SOURCES</b>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.</p><p><b>STUDY SELECTION</b>Thirty-three studies about stent placement for intracranial aneurysms were identified, which reported data from a total of 1069 patients with 1121 intracranial aneurysms.</p><p><b>DATA EXTRACTION</b>We prepared a standardized data extraction form (DEF), which was used by two independent researchers to extract data from the included 33 studies.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSIONS</b>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 dependent, but not more likely to suffer more procedure-related complications.</p>

Safety and short-term results of stent-assisted angioplasty for the treatment of intracranial arterial stenosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and short-term outcome of endovascular stent-assisted angioplasty for the treatment of intracranial arterial stenosis.</p><p><b>METHODS</b>Angioplasty and stent placement were administered to treat 46 patients with lesions of atherosclerotic intracranial stenosis, including 16 lesions of basilar artery, 12 of vertebral artery, 13 of internal carotid artery and 9 of middle cerebral artery.</p><p><b>RESULTS</b>Technical success was achieved in 49 of 50 vessels (98%), with no procedure-related death or cerebral ischemic attack. Extracranial internal carotid artery dissection occurred in 1 patient and was successfully treated with a self-expand stent. One patient had subarachnoid hemorrhage because of perforation by microwire with no permanent neurologic deficit, and another 2 patients had groin hematoma. Angiographic examination immediately after stenting revealed that the stenosis rate was significantly reduced (72.4% +/- 12.3% vs 10.6% +/- 7.8%). There was no cerebral ischemic attack in the 37 patients who were clinically followed up (6 - 18 months, mean of 8.5 months).</p><p><b>CONCLUSION</b>Angioplasty and stenting for the treatment of intracranial stenosis is safe and feasible, and it may be favorable for decreasing the incidence of ischemic attack.</p>

Treatment of posterior-communicating wide-necked aneurysms with endovascular stent and Guglielmi detachable coils / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize our clinical experience in treating posterior-communicating wide-necked aneurysms using endovascular stent and Guglielmi detachable coils (GDCs).</p><p><b>METHODS</b>The coronary stents were implanted across the neck of 32 posterior-communication wide-necked aneurysms. Microcatheters were introduced into the aneurysm sac through stent mesh, GDCs were used to embolize aneurysms.</p><p><b>RESULTS</b>All operations were successful. Total occlusion was achieved in 26 patients, over 90% in 4, 60 - 70% in 2. The patients were perfectly recovered with patency of the parent arteries.</p><p><b>CONCLUSION</b>Endovascular therapy combined with stent implatation and GDC placement is a valid approach to the treatment of posterior-communication wide-necked aneurysms.</p>