Phan Kevin, Huo Ya R, Jia Fangzhi, Phan Steven, Rao Prashanth J, Mobbs Ralph J, Mortimer Alex M
NeuroSpine Surgery Research Group (NSURG), Level 7, Prince of Wales Private Hospital, Barker Street, Randwick, NSW 2031, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW 2006, Australia.
Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW 2052, Australia.
J Clin Neurosci. 2016 Sep;31:15-22. doi: 10.1016/j.jocn.2016.01.035. Epub 2016 Jun 22.
Endovascular coil embolization is a widely accepted and useful treatment modality for intracranial aneurysms. However, the principal limitation of this technique is the high aneurysm recurrence. The adjunct use of stents for coil embolization procedures has revolutionized the field of endovascular aneurysm management, however its safety and efficacy remains unclear. Two independent reviewers searched six databases from inception to July 2015 for trials that reported outcomes according to those who received stent-assisted coiling versus coiling-only (no stent-assistance). There were 14 observational studies involving 2698 stent-assisted coiling and 29,388 coiling-only patients. The pooled immediate occlusion rate for stent-assisted coiling was 57.7% (range: 20.2%-89.2%) and 48.7% (range: 31.7%-89.2%) for coiling-only, with no significant difference between the two (odds ratio [OR}=1.01; 95% confidence intervals [CI}: 0.68-1.49). However, progressive thrombosis was significantly more likely in stent-assisted coiling (29.9%) compared to coiling-only (17.5%) (OR=2.71; 95% CI: 1.95-3.75). Aneurysm recurrence was significantly lower in stent-assisted coiling (12.7%) compared to coiling-only (27.9%) (OR=0.43; 95% CI: 0.28-0.66). In terms of complications, there was no significant difference between the two techniques for all-complications, permanent complications or thrombotic complications. Mortality was significantly higher in the stent-assisted group 1.4% (range: 0%-27.5%) compared to the coiling-only group 0.2% (range: 0%-19.7%) (OR=2.16; 95% CI: 1.33-3.52). Based on limited evidence, stent-assisted coiling shows similar immediate occlusion rates, improved progressive thrombosis and decreased aneurysm recurrence compared to coiling-only, but is associated with a higher mortality rate. Future randomized controlled trials are warranted to clarify the safety of stent-associated coiling.
血管内弹簧圈栓塞术是一种广泛接受且有效的颅内动脉瘤治疗方式。然而，该技术的主要局限性是动脉瘤复发率高。在弹簧圈栓塞手术中辅助使用支架彻底改变了血管内动脉瘤治疗领域，但其安全性和有效性仍不明确。两名独立评审员检索了从数据库建立至2015年7月的六个数据库，以查找那些根据接受支架辅助弹簧圈栓塞术与单纯弹簧圈栓塞术（无支架辅助）的患者报告结果的试验。有14项观察性研究，涉及2698例接受支架辅助弹簧圈栓塞术的患者和29388例接受单纯弹簧圈栓塞术的患者。支架辅助弹簧圈栓塞术的即时闭塞率合并值为57.7%（范围：20.2%-89.2%），单纯弹簧圈栓塞术为48.7%（范围：31.7%-89.2%），两者之间无显著差异（优势比[OR]=1.01；95%置信区间[CI]：0.68-1.49）。然而，与单纯弹簧圈栓塞术（17.5%）相比，支架辅助弹簧圈栓塞术发生进行性血栓形成的可能性显著更高（29.9%）（OR=2.71；95%CI：1.95-3.75）。与单纯弹簧圈栓塞术（27.9%）相比，支架辅助弹簧圈栓塞术的动脉瘤复发率显著更低（12.7%）（OR=0.43；95%CI：0.28-0.66）。在并发症方面，两种技术在所有并发症、永久性并发症或血栓形成并发症方面无显著差异。支架辅助组的死亡率显著高于单纯弹簧圈栓塞组，分别为1.4%（范围：0%-27.5%）和0.2%（范围：0%-19.7%）（OR=2.16；95%CI：1.33-3.52）。基于有限的证据，与单纯弹簧圈栓塞术相比，支架辅助弹簧圈栓塞术显示出相似的即时闭塞率、改善的进行性血栓形成和降低的动脉瘤复发率，但与更高的死亡率相关。有必要进行未来的随机对照试验以阐明支架辅助弹簧圈栓塞术的安全性。
