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激光切割支架和编织支架辅助弹簧圈栓塞脑动脉瘤后的临床和血管造影结果:文献的比较分析

Clinical and Angiographic Outcomes After Stent-Assisted Coiling of Cerebral Aneurysms With Laser-Cut and Braided Stents: A Comparative Analysis of the Literatures.

作者信息

Zhang Longhui, Chen Xiheng, Dong Linggen, Liu Peng, Jia Luqiong, Zhang Yisen, Lv Ming

机构信息

Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.

出版信息

Front Neurol. 2021 Apr 29;12:666481. doi: 10.3389/fneur.2021.666481. eCollection 2021.

Abstract

Stent-assisted coiling (SAC) plays an important role in endovascular treatment of intracranial aneurysms (IAs). This comparative analysis examines the safety and efficacy of SAC in general and compares clinical and angiographic outcomes between laser-cut stents and braided stents. Relevant English-language studies were identified via a PubMed search for published articles regarding outcomes of SAC using laser-cut stents and braided stents published from 2015 to 2020. Data from 56 studies that met our inclusion criteria were pooled and statistically compared. A total of 4,373 patients harboring with 4,540 IAs were included. Patients were divided into two groups on the basis of stent type: laser-cut stents (2,076 aneurysms in 1991 patients; mean follow-up, 12.99 months) and braided stents (2,464 aneurysms in 2382 patients; mean follow-up, 18.41 months). Overall, the rates of successful stent deployment, thromboembolic events, stent stenosis, periprocedural intracranial hemorrhage, permanent morbidity, mortality, and recanalization were 97.72, 4.72, 2.87, 1.51, 2.14, 1.16, and 6.06%, respectively. Laser-cut stents were associated with a significantly higher rate of successful deployment ( = 0.003) and significantly lower rate of periprocedural intracranial hemorrhage ( = 0.048). Braided stents were associated with a significantly lower rate of permanent morbidity ( = 0.015). SAC of IAs using laser-cut stents or braided stents was effective and safe. Rates of thromboembolic events, stent stenosis, mortality, and recanalization were comparable between the stent types. Braided stents were associated with lower permanent morbidity while laser-cut stents were associated with more favorable rates of successful deployment and periprocedural intracranial hemorrhage.

摘要

支架辅助弹簧圈栓塞术(SAC)在颅内动脉瘤(IA)的血管内治疗中发挥着重要作用。本比较分析研究了SAC总体的安全性和有效性,并比较了激光切割支架和编织支架之间的临床及血管造影结果。通过PubMed检索2015年至2020年发表的关于使用激光切割支架和编织支架进行SAC治疗结果的英文研究。汇总符合纳入标准的56项研究的数据并进行统计学比较。共纳入4373例患有4540个IA的患者。根据支架类型将患者分为两组:激光切割支架组(1991例患者中的2076个动脉瘤;平均随访12.99个月)和编织支架组(2382例患者中的2464个动脉瘤;平均随访18.41个月)。总体而言,支架成功置入率、血栓栓塞事件发生率、支架狭窄率、围手术期颅内出血率、永久性致残率、死亡率和再通率分别为97.72%、4.72%、2.87%、1.51%、2.14%、1.16%和6.06%。激光切割支架的成功置入率显著更高(P = 0.003),围手术期颅内出血率显著更低(P = 0.048)。编织支架的永久性致残率显著更低(P = 0.015)。使用激光切割支架或编织支架进行IA的SAC治疗是有效且安全的。两种支架类型的血栓栓塞事件发生率、支架狭窄率、死亡率和再通率相当。编织支架与较低的永久性致残率相关,而激光切割支架与更有利的成功置入率和围手术期颅内出血率相关。

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