Shao Bo, Wang Junyou, Chen Yu, He Xijun, Chen Huihui, Peng Yujiang, Yang Pengxiang, Duan Hongyu, Yang Fan, Teng Lingfang
Department of Neurosurgery, First People's Hospital of Wenling, Wenling, Zhejiang, China.
Department of Neurosurgery, First People's Hospital of Wenling, Wenling, Zhejiang, China.
World Neurosurg. 2019 Jul;127:e353-e365. doi: 10.1016/j.wneu.2019.03.123. Epub 2019 Mar 27.
The treatment strategies of ruptured intracranial aneurysms (RIAs) include surgical clipping and endovascular coiling, and the efficacy and safety of clipping versus coiling are yet controversial.
To summarize the available randomized controlled trials to determine the optimal treatment method for patients with RIA.
PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled trials published up to September 5, 2017. The summary analysis was performed using a random-effects model. The primary outcomes included poor outcome, mortality, and rebleeding, whereas the secondary outcomes included complete occlusion, incomplete occlusion, severe disability, and vegetative state.
We identified 5 trials with data collected from 2883 patients. The summary results indicated that surgical clipping in patients was associated with a high incidence of poor outcome (relative risk [RR], 1.34; 95% confidence interval [CI], 1.18-1.51; P < 0.001), whereas no significant effect was observed on mortality (RR, 1.09; 95% CI, 0.79-1.49; P = 0.608) and rebleeding (RR, 0.65; 95% CI, 0.20-2.06; P = 0.460) compared with endovascular coiling. Furthermore, we noted that surgical clipping significantly increased the incidence of complete occlusion compared with endovascular coiling (RR, 1.30; 95% CI, 1.09 1.55; P = 0.004). Conversely, surgical clipping was associated with a low incidence of incomplete occlusion (RR, 0.67; 95% CI, 0.45-0.99; P = 0.044). No significant differences were noted between surgical clipping and endovascular coiling with respect to the outcomes of severe disability (RR, 1.39; 95% CI, 0.90-2.16; P = 0.140) and vegetative state (RR, 1.35; 95% CI, 0.84-2.17; P = 0.213).
This meta-analysis provides moderate evidence that surgical clipping has few benefits than endovascular coiling for the treatment of RIA.
颅内破裂动脉瘤（RIA）的治疗策略包括外科夹闭和血管内栓塞，夹闭与栓塞的疗效和安全性仍存在争议。
总结现有随机对照试验，以确定RIA患者的最佳治疗方法。
系统检索PubMed、Embase和Cochrane图书馆截至2017年9月5日发表的随机对照试验。采用随机效应模型进行汇总分析。主要结局包括预后不良、死亡率和再出血，次要结局包括完全闭塞、不完全闭塞、严重残疾和植物状态。
我们纳入了5项试验，共收集了2883例患者的数据。汇总结果表明，与血管内栓塞相比，外科夹闭治疗的患者预后不良发生率较高（相对危险度[RR]，1.34；95%置信区间[CI]，1.18 - 1.51；P < 0.001），而对死亡率（RR = 1.09；95% CI，0.79 - 1.49；P = 0.608）和再出血率（RR = 0.65；95% CI，0.20 - 2.06；P = 0.460）无显著影响；此外，我们还发现，与血管内栓塞相比，外科夹闭显著增加了完全闭塞的发生率（RR = 1.30；95% CI，1.09 - 1.55；P = 0.004）。相反，外科夹闭的不完全闭塞发生率较低（RR = 0.67；95% CI，0.45 - 0.99；P = 0.044）。在严重残疾（RR = 1.39；95% CI，0.90 - 2.16；P = 0.140）和植物状态（RR = 1.35；95% CI，0.84 - 2.17；P = 0.213）方面，外科夹闭与血管内栓塞之间未观察到显著差异。
这项荟萃分析提供了中等强度的证据，表明对于RIA的治疗，外科夹闭的益处少于血管内栓塞。
