Department of Radiology.
AJNR Am J Neuroradiol. 2013 Sep;34(9):1769-73. doi: 10.3174/ajnr.A3598. Epub 2013 May 9.
Previous studies varied in their conclusions about the superiority of second-generation coils compared with bare platinum. In this systematic review and meta-analysis, we assessed differences in reported unfavorable angiographic outcomes of cerebral aneurysms treated with coil embolization as a function of coil type.
This systematic review covered 1999-2011 through the use of Ovid MEDLINE and EMBASE. Search terms were "subarachnoid hemorrhage," "intracranial aneurysms," "endovascular treatment," and "coiling." Inclusion criteria were studies reporting >50 aneurysms with imaging follow-up. We defined "unfavorable angiographic outcome" as either "recanalization," <90% occlusion, or "incomplete occlusion" at follow-up. Rates of unfavorable outcomes were pooled through the use of random effects models and compared across various coil types. Multivariate random effects meta-regression models were used to further explore the differences in outcomes related to coil type.
We included 82 studies, comprising 90 patient cohorts, among which, 65 (72%) used bare platinum coils, 8 (8.9%) used Matrix, 11 (12%) used HydroCoil, and 6 (6.7%) used Cerecyte. The overall unfavorable outcome rate was 19% (95% CI: 17%,21%). Unfavorable outcome rates were 20% (95% CI: 17%, 22%) for bare platinum coils, 23% (95% CI: 16%, 29%) for Matrix, 15% (95% CI: 9%, 21%) for HydroCoil, and 15% (95% CI: 7%, 23%) for Cerecyte, respectively. The difference in unfavorable outcome rates among the various coil types was not statistically significant after adjusting for baseline characteristics, including aneurysm size, rupture status, and follow-up duration.
The rate of unfavorable angiographic outcomes was not statistically different across the major approved coil types. The quality of the evidence, however, remains low because of high heterogeneity, small sample size, and potential publication bias.
既往研究对第二代线圈优于裸铂线圈的结论存在差异。本系统评价和荟萃分析旨在评估不同类型线圈栓塞治疗颅内动脉瘤后不良血管造影结果的差异。
本系统评价检索了 1999 年至 2011 年的 Ovid MEDLINE 和 EMBASE 数据库，使用的检索词包括“蛛网膜下腔出血”“颅内动脉瘤”“血管内治疗”和“线圈栓塞”。纳入标准为报道了＞50 例动脉瘤并进行影像学随访的研究。我们将“不良血管造影结果”定义为随访时存在“再通”“＜90%闭塞”或“不完全闭塞”。使用随机效应模型对不良结局发生率进行汇总，并比较各种线圈类型的结果。使用多变量随机效应荟萃回归模型进一步探讨与线圈类型相关的结局差异。
我们纳入了 82 项研究，共计 90 个患者队列，其中 65 项（72%）研究使用裸铂线圈，8 项（8.9%）研究使用 Matrix 线圈，11 项（12%）研究使用 HydroCoil 线圈，6 项（6.7%）研究使用 Cerecyte 线圈。总体不良结局发生率为 19%（95%CI：17%，21%）。裸铂线圈、Matrix 线圈、HydroCoil 线圈和 Cerecyte 线圈的不良结局发生率分别为 20%（95%CI：17%，22%）、23%（95%CI：16%，29%）、15%（95%CI：9%，21%）和 15%（95%CI：7%，23%）。调整基线特征（包括动脉瘤大小、破裂状态和随访时间）后，不同线圈类型之间的不良结局发生率差异无统计学意义。
主要批准的线圈类型之间的不良血管造影结果发生率无统计学差异。然而，由于异质性高、样本量小和潜在发表偏倚，证据质量仍然较低。
