Kang Xiao-Kui, Guo Sheng-Fu, Lei Yi, Wei Wei, Liu Hui-Xin, Huang Li-Li, Jiang Qun-Long
Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong.
Department of Gynaecology and Obstetrics, Anyi County People's Hospital, Nanchang.
Medicine (Baltimore). 2020 Mar;99(13):e19654. doi: 10.1097/MD.0000000000019654.
Endovascular coiling and surgical clipping are routinely used to treat unruptured cerebral aneurysms (UCAs). However, the evidence to support the efficacy of these approaches is limited. We aimed to analyze the efficacy of endovascular coiling compared with surgical clipping in patients with UCAs.
A systematic search of 4 databases was conducted to identify comparative articles involving endovascular coiling and surgical clipping in patients with UCAs. We conducted a meta-analysis using the random-effects model when I> 50%. Otherwise, a meta-analysis using the fixed-effects model was performed.
Our results showed that endovascular coiling was associated with a shorter length of stay (WMD: -4.14, 95% CI: (-5.75, -2.531), P < .001) and a lower incidence of short-term complications compared with surgical clipping (OR: 0.518; 95% CI (0.433, 0.621); P < .001), which seems to be a result of ischemia complications (OR: 0.423; 95% CI (0.317, 0.564); P < .001). However, surgical clipping showed a higher rate of complete occlusion after surgery, in both short-term (OR: 0.179, 95% CI (0.064, 0.499), P = .001) and 1-year follow-ups (OR: 0.307, 95% CI (0.146, 0.646), P = .002), and a lower rate of short-term retreatment (OR: 0.307, 95% CI (0.146, 0.646), P = .002). Meanwhile, there was no significant difference in postoperative death, bleeding, and modified Rankin Scale (mRS) > 2 between the 2 groups.
The latest evidence illustrates that surgical clipping resulted in lower retreatment rates and was associated with a higher incidence of complete occlusion, while endovascular coiling was associated with shorter LOS and a lower rate of complications, especially ischemia.
血管内栓塞和外科夹闭是治疗未破裂脑动脉瘤（UCA）的常用方法。然而，支持这些方法疗效的证据有限。我们旨在分析血管内栓塞与外科夹闭治疗UCA患者的疗效。
对4个数据库进行系统检索，以确定涉及UCA患者血管内栓塞和外科夹闭的比较性文章。当I>50%时，我们使用随机效应模型进行荟萃分析。否则，使用固定效应模型进行荟萃分析。
我们的结果显示，与外科夹闭相比，血管内栓塞与住院时间缩短相关（加权均数差：-4.14，95%可信区间：（-5.75，-2.531），P<0.001），短期并发症发生率较低（比值比：0.518；95%可信区间（0.433，0.621）；P<0.001），这似乎是缺血性并发症的结果（比值比：0.423；95%可信区间（0.317，0.564）；P<0.001）。然而，外科夹闭术后短期（比值比：0.179，95%可信区间（0.064，0.499），P=0.001）和1年随访时（比值比：0.307，95%可信区间（0.146，0.646），P=0.002）完全闭塞率较高，短期再治疗率较低（比值比：0.307，95%可信区间（0.146，0.646），P=0.002）。同时，两组术后死亡、出血和改良Rankin量表（mRS）>2无显著差异。
最新证据表明，外科夹闭导致再治疗率较低，且与较高的完全闭塞发生率相关，而血管内栓塞与住院时间缩短和并发症发生率较低相关，尤其是缺血性并发症。
