PT - JOURNAL ARTICLE AU - Akram, Umar AU - Ahmed, Shahzaib AU - Nadeem, Zain Ali AU - Shahriari, Mona AU - Ashraf, Hamza AU - Ashfaq, Haider AU - Fatima, Eeshal AU - Raza, Muhammad A. AU - Nadeem, Aimen AU - Majid, Zuha AU - Nadeem, Arsalan AU - Ahmad, Tayyab AU - Akram, Ammara AU - Rehman, Sana AU - Sarwar, Abeer AU - Mei, Janet AU - Deng, Francis AU - Luna, Licia P. AU - Hyson, Nathan AU - Yedavalli, Vivek S. TI - Safety And Efficacy of the Neuroform Atlas Stent for Treatment of Intracranial Aneurysms: A Systematic Review, Meta-Analysis and Meta-Regression AID - 10.3174/ajnr.A8593 DP - 2024 Nov 22 TA - American Journal of Neuroradiology PG - ajnr.A8593 4099 - http://www.ajnr.org/content/early/2024/11/22/ajnr.A8593.short 4100 - http://www.ajnr.org/content/early/2024/11/22/ajnr.A8593.full AB - BACKGROUND: Intracranial aneurysms (IAs) are the major cause of subarachnoid hemorrhage. Stent-assisted coiling, especially with the Neuroform Atlas stent (NAS), has proven 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 NAS in treating IAs.DATA SOURCES: A comprehensive literature search was conducted on PubMed, Embase, Cochrane CENTRAL library, and clinicaltrials.gov from inception till 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 using the Raymond-Roy classification (RROC). The modified Rankin Scale (mRS) and adverse events related to stent use were also recorded.DATA ANALYSIS: The statistical analysis was conducted on R version 4.3.2 using the packages “meta” and “metasens”. We reported our results as proportions with their corresponding confidence intervals (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 analyse 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 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.ABBREVIATIONS: NAS = Neuroform Atlas stent; IA = Intracranial aneurysm; SAC = stent-assisted coiling