RT Journal Article
SR Electronic
T1 Safety and Efficacy of the Neuroform Atlas Stent for Treatment of Intracranial Aneurysms: A Systematic Review, Meta-Analysis, and Meta-Regression
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A8593
A1 Akram, Umar
A1 Ahmed, Shahzaib
A1 Nadeem, Zain Ali
A1 Shahriari, Mona
A1 Ashraf, Hamza
A1 Ashfaq, Haider
A1 Fatima, Eeshal
A1 Raza, Ahmed
A1 Nadeem, Aimen
A1 Majid, Zuha
A1 Nadeem, Arsalan
A1 Ahmed, Tayyab
A1 Akram, Ammara
A1 Rehman, Sana
A1 Sarwar, Abeer
A1 Mei, Janet
A1 Deng, Francis
A1 Pacheco-Luna, Licia
A1 Hyson, Nathan
A1 Yedavalli, Vivek S.
YR 2025
UL http://www.ajnr.org/content/early/2025/05/22/ajnr.A8593.abstract
AB BACKGROUND: Intracranial aneurysms (IAs) are the major cause of subarachnoid hemorrhage. Stent-assisted coiling, especially with the Neuroform Atlas stent (NAS), has proved more effective than coiling alone for treating these aneurysms.PURPOSE: To perform a systematic review and meta-analysis to investigate the efficacy and safety of the NAS in treating IAs.DATA SOURCES: A comprehensive literature search was conducted on PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov from inception until June 2024.STUDY SELECTION: We included studies on ruptured and unruptured IAs treated with the NAS, covering experimental, observational, and case series across all age groups. The aneurysm occlusion rate was assessed by using the Raymond-Roy classification (RROC). The mRS and adverse events related to stent use were also recorded.DATA ANALYSIS: The statistical analysis was conducted on R Version 4.3.2 by using the packages “meta” and “metasens.” We reported our results as proportions with their corresponding CIs. Meta-regression, leave-one-out, and sensitivity analyses were conducted to confirm the robustness of our results.DATA SYNTHESIS: A total of 42 studies including 2434 participants with a mean age of 51 to 73 years were included. Among angiographic outcomes, the final RROC 1/RROC 2 was achieved in 95% of the patients, final RROC 1 in 82%, RROC 2 in 12%, and RROC 3 in 5% of the patients. Additionally, 93% of the patients showed mRS grade 0, 5% showed mRS grade 1, 3% showed mRS grade 2, 2% showed mRS grade 3, 0% showed mRS grade 4, 0% showed mRS grade 5, and 1% showed mRS grade 6. All adverse events had a ≤5% rate.LIMITATIONS: Due to limited cause-specific data, we were unable to analyze mortality specific to the stent placement and complications. Despite the large number of studies included, comparative studies were still observed to be scarce.CONCLUSIONS: Although the generalizability of our findings is limited, this study demonstrates that the NAS is highly effective for treating IAs, with high occlusion rates and a low incidence of adverse events. The stent’s performance, supported by comprehensive analysis, highlights its safety and efficacy in managing both ruptured and unruptured aneurysms.EVTendovascular therapyGLMMgeneralized linear mixed modelsNASNeuroform Atlas stentNHLBINational Heart, Lung, and Blood InstitutePFTFreeman-Tukey double arcsine transformationPRISMAPreferred Reporting Items for Systematic Review and Meta-AnalysisRROCRaymond-Roy classificationSACstent-assisted coiling