AUTHOR=Wei Yanpeng , Zhang Xiaoxi , Zhang Renkun , Zhang Guanghao , Shang Chenghao , Chen Rundong , Li Dan , Huyan Meihua , Wu Congyan , Zong Kang , Feng Zhengzhe , Dai Dongwei , Li Qiang , Huang Qinghai , Xu Yi , Yang Pengfei , Zhao Rui , Zuo Qiao , Liu Jianmin 

TITLE=Staged stenting strategy of acutely wide-neck ruptured intracranial aneurysms: A meta-analysis and systematic review

JOURNAL=Frontiers in Neurology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1070847

DOI=10.3389/fneur.2023.1070847

ISSN=1664-2295

ABSTRACT=<sec><title>Objective</title><p>In the study, we explored the safety and effectiveness of staged stenting strategy for acutely wide-neck ruptured intracranial aneurysms.</p></sec><sec><title>Methods</title><p>Online databases, including PubMed, EMBASE, the Cochrane database, and Web of Science, were retrospectively and systematically searched. The main observation indicators were the procedure-related complication rate, complete occlusion rate, and favorable clinical outcome. Meta-analysis was performed using a random or fixed effect model based on heterogeneity.</p></sec><sec><title>Results</title><p>A total of 5 studies with 143 patients were included. The hemorrhagic complication rate of the initial coiling and staged stenting was 2.8% (4 of 143) and 0, respectively. The ischemic complication rate of the coiling and supplemental stenting was 3.5% (5 of 143) and 2.9% (4 of 139), respectively. There were no deaths due to procedure-related complications in two stages. The aneurysm complete occlusion rate was 25% (95% CI, 0.13–0.03; I<sup>2</sup> = 4.4%; <italic>P</italic> = 0.168) after initial coiling, 54% (95% CI, 0.63–0.64; I<sup>2</sup> = 0%; <italic>P</italic> = 0.872) after staged stenting, and 74% (95% CI, 0.66–0.81; I<sup>2</sup> = 56.4%; <italic>P</italic> = 0.562) at follow-up, respectively. Favorable clinical outcome rate 74% (95% CI, 0.61–0.86; I<sup>2</sup> = 50.5%; <italic>P</italic> = 0.133) after discharge of initial coiling treatment, and 86% (95% CI, 0.80–0.92; I<sup>2</sup> = 0; <italic>P</italic> = 0.410) after discharge from stenting, and 97% (95% CI, 0.93–1.01; I<sup>2</sup> = 43.8%; <italic>P</italic> = 0.130) at follow-up.</p></sec><sec><title>Conclusion</title><p>Staged stenting treatment of wide-neck RIA with coiling in the acute phase followed by delayed regular stent or flow-diverter stent had high aneurysm occlusion rate, favorable clinical outcome rate and low procedure-related complication rate. A more dedicated and well-designed controlled study is warranted for further evaluation of staged stenting treatment compared to SCA in wide-neck RIA.</p></sec>