Overlapping Stents for Dissecting Intracranial Aneurysms: A Systematic Review With Single-Arm Meta-Analysis

Abstract

Purpose:

To assess the safety, efficacy, and clinical outcomes of overlapping stent-assisted reconstruction for dissecting intracranial aneurysms (DIAs) through a systematic review and single-arm meta-analysis.

Methods:

A systematic search of PubMed, Embase, and the Cochrane Library was conducted up to March 2025 for studies reporting outcomes of patients with angiographically confirmed DIAs treated with overlapping stents. Retrospective or prospective series including ≥5 patients were eligible. Data on angiographic, functional, and procedural outcomes were extracted. Pooled prevalence and 95% confidence intervals (CIs) were calculated under a random-effects model (DerSimonian-Laird). Study quality was evaluated using the Newcastle-Ottawa Scale.

Results:

Eleven retrospective studies encompassing 261 patients were included. The technical success rate was 95.5% (95% CI: 90.8–97.9), and complete aneurysm occlusion at follow-up was achieved in 83.9% (95% CI: 73.3–90.8). Immediate Raymond grade I occlusion occurred in 46.9%, grade II in 27.5%, and grade III in 34.2%. Recanalization and recurrence rates were 13.6% and 9.8%, respectively. A favorable clinical outcome (mRS=0–2) was observed in 91.5% (95% CI: 85.1–95.3), while moderate-to-severe disability (mRS=3–6) occurred in 8.5%. Ischemic complications were seen in 11.3% (95% CI: 6.9–17.9), hemorrhagic complications in 2.3% (95% CI: 0.7–7.0), and in-stent stenosis in 7.1% (95% CI: 3.6–13.6). Sensitivity analysis confirmed the stability of pooled estimates, and methodological quality ranged from moderate to high.

Conclusion:

Overlapping stent-assisted reconstruction achieves high aneurysm occlusion and favorable neurological outcomes with low complication rates, supporting its role as a safe and effective reconstructive option for DIAs.

Clinical Impact

The findings support overlapping stent-assisted reconstruction as a viable reconstructive strategy for dissecting intracranial aneurysms, particularly in anatomically complex or rupture-prone lesions where parent artery preservation is critical. High rates of technical success and favorable functional outcomes, coupled with low complication rates, suggest that this approach may expand the therapeutic armamentarium beyond conventional deconstructive techniques. For clinicians, it provides a feasible alternative in scenarios where flow diversion or vessel sacrifice is contraindicated. The innovation lies in leveraging standard stents to achieve flow-modulating effects comparable to dedicated devices, enabling tailored, cost-effective, and anatomically adaptable endovascular reconstruction.