Zhang Jie, Jiang Guannan, Song Zhaoming, Cheng Wei, Wu Wenxue, Chen Zhouqing, Wang Zhong, You Wanchun, Chen Gang
Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China.
Brain Sci. 2022 Aug 10;12(8):1062. doi: 10.3390/brainsci12081062.
Bioactive coils have been used for nearly 20 years to improve aneurysm treatments. Previous studies are inadequate for comparing the efficacy and safety between different coils. The aim of this study was to investigate the safety and efficacy of different coils by comparing the percentage of people with different modified Raymond scale grades, re-rupture rates, and mortality in patients with intracranial aneurysms embolized with different coils.
Randomized controlled trials (RCTs) containing coils for aneurysm interventional treatment were collected from Web of Science, PubMed, and the Cochrane Library up to December 2021. Bayesian network meta-analysis with a randomized or fixed model was performed to compare the efficacy and safety among different bioactive coils and bare platinum coils.
We pooled 3362 patients from eight RCTs. No significant differences were found between coils in the proportion of patients with a three-grade classification assessed with the modified Raymond scale immediately after surgery. Hydrogel coils did not show a significant difference in the percentage of patients with a modified Raymond scale grade I postoperatively compared with bare platinum coils (OR, -0.1080; 95% CI, -0.4201-0.2423), but at follow-up, the percentage of patients with modified Raymond scale grade I was significantly higher with hydrogel coils than with bare platinum coils (OR, 0.4957; 95% CI, 0.0060-0.9442). There were no statistical differences between these four coils in terms of aneurysm rupture or re-rupture rate and mortality.
Though there was no significant difference in the embolization effect between the several coils in the postoperative period, complete embolization was more likely to be achieved with hydrogel coils compared to bare platinum coils at follow-up. There were no significant differences in safety between the several coil materials.
生物活性弹簧圈已用于改善动脉瘤治疗近20年。以往的研究不足以比较不同弹簧圈之间的疗效和安全性。本研究的目的是通过比较不同弹簧圈栓塞颅内动脉瘤患者中不同改良雷蒙德分级的患者比例、再破裂率和死亡率，来研究不同弹簧圈的安全性和疗效。
截至2021年12月，从Web of Science、PubMed和Cochrane图书馆收集包含用于动脉瘤介入治疗弹簧圈的随机对照试验（RCT）。采用随机或固定模型进行贝叶斯网络荟萃分析，以比较不同生物活性弹簧圈和裸铂金弹簧圈之间的疗效和安全性。
我们汇总了来自8项RCT的3362例患者。术后立即用改良雷蒙德量表评估的三级分类患者比例在不同弹簧圈之间未发现显著差异。与裸铂金弹簧圈相比，水凝胶弹簧圈术后改良雷蒙德量表I级患者的百分比没有显著差异（OR，-0.1080；95%CI，-0.4201-0.2423），但在随访时，水凝胶弹簧圈改良雷蒙德量表I级患者的百分比显著高于裸铂金弹簧圈（OR，0.4957；95%CI，0.0060-0.9442）。这四种弹簧圈在动脉瘤破裂或再破裂率及死亡率方面无统计学差异。
虽然几种弹簧圈在术后栓塞效果上无显著差异，但随访时与裸铂金弹簧圈相比，水凝胶弹簧圈更有可能实现完全栓塞。几种弹簧圈材料在安全性方面无显著差异。
