Papadopoulos Filippos, Antonopoulos Constantine Nikolaos, Geroulakos George
Department of Neurosurgery, "KAT" General Hospital, Athens, Greece.
Department of Vascular Surgery, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Asian J Neurosurg. 2020 Dec 21;15(4):821-827. doi: 10.4103/ajns.AJNS_57_20. eCollection 2020 Oct-Dec.
Morbidity and mortality in patients experiencing the rupture of intracranial aneurysm ruptures are high. We conducted a systematic review and meta-analysis to investigate the role of stent-assisted coiling (SAC) for unruptured intracranial aneurysms (UIAs) with wide neck.
The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled proportions with 95% confidence intervals (CIs) of ten outcomes of interest were calculated.
We finally reviewed 13 studies, including 976 patients. The technical success of the method was 98.43% (95% CI: 95.62-99.95). Early outcomes included total periprocedural obliteration with a rate of 50.20% (95% CI: 36.09-64.30) and periprocedural rupture with zero rate. During the follow-up period, ranging from 6 months to 2 years, the total postprocedural obliteration rate was 63.83% (95% CI: 45.80-80.18) and the overall late rupture rate was 0.41% (95% CI: 0.00-2.38). The pooled in-stent stenosis rate was calculated at 1.24% (95% CI: 0.02-3.63). We also estimated a pooled rate of 0.02% (95% CI: 0.00-0.51) and 4.33% (95% CI: 2.03-7.23) for total mortality and overall neurological complications, respectively. A pooled rate of 3.94% (95% CI: 1.48-7.33) was found for stroke. Finally, the recanalization rate was recorded at 7.07% (95% CI: 4.35-10.26).
SAC of UIAs with wide neck seems to be a safe and acceptable alternative to surgical clipping. Although early results concerning total periprocedural obliteration may be modest, follow-up outcomes may be indicative of adequate occlusion of treated UIAs.
颅内动脉瘤破裂患者的发病率和死亡率很高。我们进行了一项系统评价和荟萃分析，以研究支架辅助弹簧圈栓塞术（SAC）在治疗宽颈未破裂颅内动脉瘤（UIA）中的作用。
本荟萃分析按照系统评价和荟萃分析的首选报告项目指南进行。计算了10项感兴趣结局的合并比例及95%置信区间（CI）。
我们最终纳入了13项研究，共976例患者。该方法的技术成功率为98.43%（95%CI：95.62-99.95）。早期结局包括围手术期完全闭塞率为50.20%（95%CI：36.09-64.30），围手术期破裂率为零。在6个月至2年的随访期内，术后完全闭塞率为63.83%（95%CI：45.80-80.18），总体迟发性破裂率为0.41%（95%CI：0.00-2.38）。支架内狭窄合并率计算为1.24%（95%CI：0.02-3.63）。我们还分别估计总死亡率合并率为0.02%（95%CI：0.00-0.51），总体神经并发症合并率为4.33%（95%CI：2.03-7.23）。卒中合并率为3.94%（95%CI：1.48-7.33）。最后，再通率记录为7.07%（95%CI：4.35-10.26）。
宽颈UIA的SAC似乎是手术夹闭的一种安全且可接受的替代方法。尽管围手术期完全闭塞的早期结果可能不太理想，但随访结果可能表明治疗的UIA得到了充分闭塞。
