Authors' objectives:

This study aims to assess the effectiveness and safety of vascular endoprostheses (stents) in the treatment of cerebral aneurysms, whether used in isolation or jointly with thrombogenic coils.

Authors' results and conclusions: Ten case series were selected which met the established inclusion criteria. We nevertheless failed to locate any randomized clinical trials -whether concluded or in progress- systematic reviews or economic studies which addressed the target subject, something that underscores the novelty of this technique. In some cases, methodological limitations were in evidence, such as the lack of an adequate description of the selection criteria or failure to incorporate a definition of the study variables, while the outcomes reported in the respective case series proved difficult to compare, due to differences between the patients selected, follow-up periods or result-assessment criteria. A total of 285 lesions were treated, 76% of which were wide neck aneurysms, i.e., with a neck exceeding 4.5 mm and/or a sac/neck ratio less than or equal to 2. Insofar as aneurysm occlusion was concerned, stents were only used in 12% of cases, stents followed by coils in 82%, and other procedures in the remainder. Effectiveness was assessed on the basis of the degree of occlusion of the aneurysm, with an occlusion of over 95% being achieved in close on 77% of cases. Among the 281 patients included, there were 10 deaths (3.6%) and 42 complications (15%), 55% of which were thromboembolic in nature. Special mention should be made of 47 cases (16.5%) in which difficulties in positioning the stent, stent dislodgment, or other technical problems were experienced.

Authors' recommendations: The characteristics of wide neck aneurysms render them poor candidates for being occluded solely by embolization with coils, which explains why the technique of stent placement as an adjuvant to embolization has been developed in recent years. Although the absence of acceptable methodological quality studies means that no definitive and categorical conclusions can be reached at this point in time, joint application of coils and vascular endoprostheses would appear to obtain high percentages of effectiveness, with aneurysmal occlusions of over 95% in more than 75% of cases. Moreover, the observed percentages of morbidity and mortality are comparable to those obtained by surgery. Thus, to gain better knowledge of the safety and efficacy of this technology, randomized clinical trials should be undertaken to compare it with other therapeutic options, provided that appropriate and uniform selection criteria are defined for both patients and centers, and that there is strict follow-up, data collection and assessment of outcomes achieved. In conclusion, while the dearth of quality studies means that endoprostheses cannot be currently recommended in standard treatment of wide neck aneurysms, the results obtained to date allow for the possibility that this technology may herald a new dimension in the treatment of these types of vascular lesions.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.sergas.es/MostrarContidos_N3_T02.aspx?IdPaxina=60058&uri=http://www.sergas.es/gal/Servicios/docs/AvaliacionTecnoloxias/CT2005_05%20Endoprotesis%20Vas.pdf&hifr=750&seccion=0

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Scientific Advice Unit, avalia-t; The Galician Health Knowledge Agency (ACIS)

Contact Address: Conselleria de Sanidade, Xunta de Galicia, San Lazaro s/n 15781 Santiago de Compostela, Spain. Tel: 34 981 541831; Fax: 34 981 542854;

Contact Name: avalia-t@sergas.es

Contact Email: avalia-t@sergas.es

Copyright: Galician Agency for Health Technology Assessment (AVALIA-T)