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The Egyptian Journal of Neurosurgery : the official publication of the Egyptian Society of Neurological Surgeons/Egyptian journal of neurosurgery
By Anfal Binte Amin, Fatima Yousaf, S. M. Aleem Hussain and 20 others.
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Abstract Background Stent-assisted coiling (SAC) has been increasingly adopted to treat unruptured intracranial aneurysms (UIAs), particularly for wide-neck aneurysms, for which conventional coiling may be technically challenging. However, its comparative safety and effectiveness relative to non-stent-assisted coiling (non-SAC) remain uncertain. This systematic review and meta-analysis evaluated the clinical and angiographic outcomes of SAC versus non-SAC in patients with UIAs. Methods A systematic search of PubMed, Embase, and the Cochrane Library was conducted from database inception to July 30, 2025. Randomized controlled trials and observational studies comparing SAC with non-SAC in adults with UIAs were included. Two reviewers independently performed study selection, data extraction, and quality assessment. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models in Review Manager 5.4. Results Eight studies involving 7,682 patients met the inclusion criteria, including one randomized controlled trial and seven observational studies. SAC was associated with a significantly higher rate of complete aneurysm occlusion at follow-up (RR 1.19, 95% CI 1.09–1.29), while no significant differences were observed in initial complete occlusion, aneurysm recurrence, intraprocedural rupture, or hemorrhagic complications. However, SAC was associated with a significantly greater risk of ischemic events compared with non-SAC (RR 1.81, 95% CI 1.51–2.19). Overall certainty of the evidence was limited by the predominance of observational studies and the risk of bias in the single randomized trial. Conclusion Compared with non-stent-assisted coiling, SAC improves long-term angiographic occlusion but increases the risk of ischemic complications without demonstrating clear advantages in recurrence or procedural safety. These findings support an individualized treatment approach based on aneurysm characteristics and patient-specific factors rather than routine use of SAC for all unruptured intracranial aneurysms.
Published in The Egyptian Journal of Neurosurgery : the official publication of the Egyptian Society of Neurological Surgeons/Egyptian journal of neurosurgery. The abstract is shown as published and remains the work of its authors; read the full article at the source.
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