RT Journal Article
SR Electronic
T1 Stent Angioplasty for the Treatment of Cerebral Vasospasm: A Systematic Review and Meta-Analysis
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 943
OP 949
DO 10.3174/ajnr.A8617
VO 46
IS 5
A1 Cortese, Jonathan
A1 Bayraktar, Esref Alperen
A1 Ghozy, Sherief
A1 Zarrintan, Armin
A1 Bilgin, Cem
A1 Brinjikji, Waleed
A1 Kadirvel, Ramanathan
A1 Bhogal, Pervinder
A1 Kallmes, David F.
YR 2025
UL http://www.ajnr.org/content/46/5/943.abstract
AB BACKGROUND: Several case series and prospective cohorts have reported the use of stent retrievers (SR) and specifically designed expanding stents (ES) to perform in situ mechanical stent angioplasty to treat cerebral vasospasm in subarachnoid vasospasm.PURPOSE: The aim of this study was to review and conduct a meta-analysis to evaluate the safety and efficacy of this novel technique.DATA SOURCES: A systematic review and meta-analysis was conducted according to established protocols. Searches were conducted in PubMed, Scopus, Web of Science, and EMBASE databases up to June 2024, including variations of “stent,” “expanding device,” “vasospasm,” “subarachnoid hemorrhage.” Original studies reporting treatment outcomes for vasospasm by using SR/ES in more than 5 patients were included.STUDY SELECTION: Pooled data from 8 studies, comprising 156 patients and 428 targeted vessels treated with stent angioplasty for vasospasm were analyzed.DATA ANALYSIS: We evaluated rates of angiographic success, complications, recurrence, and neurologic improvement. Meta-analysis was performed by using a random-effects model.DATA SYNTHESIS: The angiographic success rate was 81.8% (95% CI: 70.6–89.3). Subgroup analysis showed a success rate of 86.5% (95% CI: 62.6–96.1) with ES and 80.5% (95%CI: 62.6–93.1) with SR. Overall complication rate was 1.1% (95% CI: 0.0–3.6), due to clot formation or hemorrhage. Recurrence of vasospasm was noted in 12.8% (95% CI: 5.2–28.1) while neurologic improvement was seen in 65.9% (95% CI: 51.1–78.1) of the cases. Finally, it should be noted that all included studies used stent angioplasty in combination with intra-arterial vasodilators.LIMITATIONS: Our meta-analysis is limited by selection and reporting biases, as well as high heterogeneity. Moreover, the overall low quality of available evidence is the main limitation of our results.CONCLUSIONS: Combination of stent angioplasty and intra-arterial vasodilators was found to have high rates of angiographic success and low incidences of adverse events. Randomized controlled trials are needed to confirm their efficacy and safety compared with medical and balloon angioplasty treatments.aSAHaneurysmal SAHESexpanding stent(s)SRstent retriever(s)