Hassankhani Amir, Ghozy Sherief, Bilgin Cem, Kadirvel Ramanathan, Kallmes David F
Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA.
Department of Neurological Surgery, 6915Mayo Clinic, Rochester, MN, USA.
Interv Neuroradiol. 2023 Feb 12:15910199231155288. doi: 10.1177/15910199231155288.
Endovascular coil embolization (ECE) for intracranial aneurysms has been proven as an effective minimally invasive treatment. However, the aneurysm recanalization after coiling is a serious complication of this technique. Among all the proposed factors associated with recanalization, the impact of packing density (PD) is still controversial.
To clarify the role of PD in the aneurysm recanalization following ECE, via conducting a systematic review and meta-analysis.
A systematic literature search was conducted using PubMed, Scopus, Embase, and Web of Science databases, until November 28, 2022, by adhering to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement guidelines. Considering the eligibility criteria, all the studies reporting the outcomes of interest were included. Data elements of interest were extracted and analyzed using R software version 4.2.1.
The pooled analysis of the 17 eligible papers revealed a 29% higher PD of the nonrecanalized aneurysms (ROM = 1.29, 95% confidence interval [CI] = 1.18-1.40, < 0.001), even after removing outlier studies to reduce heterogeneity. However, the pooled estimates from multivariable regression models within nine included studies showed no significant effect of PD on recanalization odds when incorporated into a multivariable model with other predictors (odds ratio [OR] = 0.93, 95% CI = 0.84-1.02, = 0.126), even after removing outlier studies.
The current literature does not support PD as a significant predictor of aneurysm treatment outcomes, especially with adjusting for other variables. This finding necessitates further prospective multicenter studies with a larger sample size to overcome the current methodological shortcomings.
颅内动脉瘤血管内弹簧圈栓塞术（ECE）已被证明是一种有效的微创治疗方法。然而，弹簧圈栓塞后动脉瘤再通是该技术的严重并发症。在所有提出的与再通相关的因素中，填充密度（PD）的影响仍存在争议。
通过系统评价和荟萃分析，阐明PD在ECE术后动脉瘤再通中的作用。
按照系统评价和荟萃分析的首选报告项目声明指南，使用PubMed、Scopus、Embase和Web of Science数据库进行系统文献检索，截至2022年11月28日。根据纳入标准，纳入所有报告感兴趣结局的研究。使用R软件4.2.1版提取和分析感兴趣的数据元素。
对17篇符合条件的论文进行汇总分析发现，即使剔除异常值研究以减少异质性，未再通动脉瘤的PD仍高出29%（风险比[ROM]=1.29，95%置信区间[CI]=1.18-1.40，P<0.001）。然而，纳入的9项研究中多变量回归模型的汇总估计显示，当与其他预测因素纳入多变量模型时，PD对再通几率无显著影响（优势比[OR]=0.93，95%CI=0.84-1.02，P=0.126），即使剔除异常值研究后也是如此。
当前文献不支持将PD作为动脉瘤治疗结局的重要预测因素，尤其是在调整其他变量后。这一发现需要进一步开展更大样本量的前瞻性多中心研究，以克服当前的方法学缺陷。
