水凝胶弹簧圈与裸铂弹簧圈用于颅内动脉瘤血管内治疗的随机对照试验的荟萃分析

Hydrogel coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms: a meta-analysis of randomized controlled trials.

作者信息

Xue Tao, Chen Zhouqing, Lin Weiwei, Xu Jiayi, Shen Xuming, Wang Zhong

机构信息

Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China.

University of Pittsburgh School of Pharmacy, Pittsburgh, PA, 15219, USA.

出版信息

BMC Neurol. 2018 Oct 5;18(1):167. doi: 10.1186/s12883-018-1171-8.

BACKGROUND

Recent studies have shown conflicting results regarding the effect of hydrogel coils for treating intracranial aneurysm compared to bare platinum coils. We implemented a meta-analysis to assess the value of hydrogel coils in intracranial aneurysm treatment.

METHODS

The MEDLINE, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) which had evaluated hydrogel coils versus bare platinum coils for intracranial aneurysms.

RESULTS

We pooled 1526 patients from 4 RCTs with the mean follow-up time of more than 16 months. Hydrogel coils had reductions on mid-term recurrence (RR 0.78, 95% CI 0.65 to 0.94, P = 0.008) and residual aneurysm (RR 0.71, 95% CI 0.57 to 0.88, P = 0.002), but didn't show any significant differences in other favorable outcomes such as functional recovery, mortality and so on. In the subgroup analysis, we found that second-generation hydrogel coils might exhibit potential impacts on increasing mid-term complete occlusion (RR 1.26, 95% CI 1.07 to 1.48, P = 0.005) and decreasing residual aneurysm neck. (RR 0.54, 95% CI 0.34 to 0.86, P = 0.010).

CONCLUSIONS

Hydrogel coils showed no significant efficacy on functional recovery but exhibited a lower rate of recurrences and residual aneurysms in patients with intracranial aneurysms.

背景

与裸铂弹簧圈相比，近期研究显示水凝胶弹簧圈治疗颅内动脉瘤的效果存在相互矛盾的结果。我们进行了一项荟萃分析，以评估水凝胶弹簧圈在颅内动脉瘤治疗中的价值。

方法

检索MEDLINE、EMBASE和Cochrane图书馆数据库，查找评估水凝胶弹簧圈与裸铂弹簧圈治疗颅内动脉瘤的随机对照试验（RCT）。

结果

我们汇总了来自4项RCT的1526例患者，平均随访时间超过16个月。水凝胶弹簧圈可降低中期复发率（RR 0.78，95%CI 0.65至0.94，P = 0.008）和残余动脉瘤发生率（RR 0.71，95%CI 0.57至0.88，P = 0.002），但在功能恢复、死亡率等其他良好结局方面未显示出任何显著差异。在亚组分析中，我们发现第二代水凝胶弹簧圈可能对提高中期完全闭塞率（RR 1.26，95%CI 1.07至1.48，P = 0.005）和减少残余动脉瘤颈有潜在影响（RR 0.54，95%CI 0.34至0.86，P = 0.010）。