Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
World Neurosurg. 2019 Jun;126:e295-e313. doi: 10.1016/j.wneu.2019.02.047. Epub 2019 Feb 28.
To evaluate the safety and efficacy of dual stent-assisted coiling in treatment of intracranial complex and wide-necked bifurcation aneurysms, we have reported our own center experience and performed a systematic review and meta-analysis of the reported data.
The experience in our center was reviewed and a comprehensive search of the reported data on dual stent-assisted treatment of intracranial complex and wide-necked bifurcation aneurysms was performed using the databases PubMed, Ovid EMBASE, and Ovid MEDLINE before October 1, 2018. Information was extracted regarding patient demographic data, clinical characteristics, radiographic data, treatment outcomes, complications, and clinical and angiographic follow-up data. The data were analyzed using random effects and fixed effects meta-analyses.
Including our series of 26 patients, the data from 21 studies with 721 patients were analyzed. The procedure was technically successful in 97.6% (95% confidence interval [CI], 96.5%-98.7%). The complete occlusion rate was 61.6% (95% CI, 47.3%-75.8%) immediately after the procedure compared with 88.4% (95% CI, 84.6%-92.2%) at the last follow-up examination. The rate of periprocedural complications, total complications, procedure-related mortality was 8.8% (95% CI, 5.8%-11.9%), 9.5% (95% CI, 6.2%-12.9%), and 1.1% (95% CI, 0.3%-1.8%), respectively. The recurrence rate, retreatment rate, and good neurologic outcome rate was 3.3% (95% CI, 2.0%-4.7%), 2.7% (95% CI, 1.5%-4.0%), and 96.6% (95% CI, 95.0%-98.1%), respectively.
The dual stent-assisted coiling technique is a feasible and effective option for the treatment of intracranial complex and wide-necked bifurcation aneurysms. It results in a relatively low rate of procedure-related complications and mortality and recurrence and a high rate of mid-term complete occlusion and good neurologic outcomes.
评估双支架辅助弹簧圈栓塞术治疗颅内复杂及宽颈分叉部动脉瘤的安全性和有效性，我们报告了我们中心的经验，并对已发表的数据进行了系统回顾和荟萃分析。
回顾了我们中心的经验，并使用数据库 PubMed、Ovid EMBASE 和 Ovid MEDLINE 对截至 2018 年 10 月 1 日报告的双支架辅助治疗颅内复杂及宽颈分叉部动脉瘤的数据进行了全面检索。提取患者人口统计学数据、临床特征、影像学数据、治疗结果、并发症以及临床和血管造影随访数据。使用随机效应和固定效应荟萃分析对数据进行分析。
包括我们的 26 例患者，共分析了 21 项研究的 721 例患者的数据。该手术在技术上成功率为 97.6%（95%可信区间，96.5%-98.7%）。术后即刻完全闭塞率为 61.6%（95%可信区间，47.3%-75.8%），而末次随访时为 88.4%（95%可信区间，84.6%-92.2%）。围手术期并发症、总并发症和与手术相关的死亡率分别为 8.8%（95%可信区间，5.8%-11.9%）、9.5%（95%可信区间，6.2%-12.9%）和 1.1%（95%可信区间，0.3%-1.8%）。复发率、再治疗率和良好神经功能结局率分别为 3.3%（95%可信区间，2.0%-4.7%）、2.7%（95%可信区间，1.5%-4.0%）和 96.6%（95%可信区间，95.0%-98.1%）。
双支架辅助弹簧圈栓塞术是治疗颅内复杂及宽颈分叉部动脉瘤的一种可行且有效的方法。它导致与手术相关的并发症和死亡率以及复发率相对较低，而中期完全闭塞和良好神经功能结局率较高。
