Kesumayadi Irfan, Sakamoto Makoto, Hosoya Tomohiro, Kambe Atsushi, Uno Tetsuji, Yoshioka Hiroki, Kurosaki Masamichi
From the Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan.
From the Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
AJNR Am J Neuroradiol. 2025 Feb 3;46(2):272-277. doi: 10.3174/ajnr.A8443.
The use of a Pipeline Embolization Device (PED) in combination with coils (PEDC) to treat intracranial aneurysms remains unclear as to whether it offers significant benefits for the patients because the results have varied.
This study aimed to investigate the clinical outcome of the PEDC compared with the PED in treating intracranial aneurysms.
We systematically searched the articles from PubMed, Web of Science, and the Cochrane Library databases published before January 25, 2024.
We selected studies comparing the PEDC versus the PED to treat intracranial aneurysms. Patients treated with the PEDC but using dense coiling were excluded from the study.
The clinical outcomes observed in this meta-analysis were intraprocedural complications, postoperative complications (stenosis, stroke, hemorrhage, mortality), favorable outcome (mRS ≤2), complete occlusion rate, and retreatment rate. A forest plot was used to analyze pooled OR of clinical outcomes.
A total of 3001 subjects from 9 observational studies were included. The PEDC was mainly used to treat larger aneurysms. The PEDC has a significantly higher complete occlusion rate at 6 months (OR = 2.66; 95% CI, 1.26-115.59; = .01), a lower retreatment rate (OR = 0.18; 95% CI, 0.05-0.07; = .010), higher stroke-related complications (OR= 1.66, 95% CI, 1.16-2.37; = .005), and higher hemorrhage-related complications (OR = 1.98; 95% CI, 1.22-13.21; = .005). There was no significant difference in intraprocedural complications, stenosis-related complications, mortality, favorable outcomes, and complete occlusion at the end of the study.
No randomized controlled trials have been performed comparing the PEDC and PED. Considering that all the included studies were observational, the patients' baseline characteristics were not completely balanced.
This meta-analysis study showed that the PEDC in large intracranial aneurysms induces a faster complete occlusion rate at 6 months and a lower retreatment rate. However, it increases the risk of stroke-related postoperative complications, and the faster complete aneurysm occlusion rate found in this study did not correlate with a reduction in long-term aneurysm or distal artery ruptures. Thus, this study suggests the need to find a better strategy to improve long-term hemorrhage-related complications in large intracranial aneurysms.
使用管道栓塞装置（PED）联合弹簧圈（PEDC）治疗颅内动脉瘤对患者是否具有显著益处仍不明确，因为结果存在差异。
本研究旨在探讨PEDC与PED治疗颅内动脉瘤的临床结局。
我们系统检索了截至2024年1月25日在PubMed、科学网和考克兰图书馆数据库上发表的文章。
我们选择了比较PEDC与PED治疗颅内动脉瘤的研究。接受PEDC治疗但使用致密弹簧圈栓塞的患者被排除在本研究之外。
本荟萃分析中观察到的临床结局包括术中并发症、术后并发症（狭窄、卒中、出血、死亡）、良好结局（改良Rankin量表评分≤2分）、完全闭塞率和再治疗率。采用森林图分析临床结局的合并比值比。
共纳入9项观察性研究的3001名受试者。PEDC主要用于治疗较大的动脉瘤。PEDC在6个月时具有显著更高的完全闭塞率（比值比=2.66；95%置信区间，1.26 - 115.59；P = 0.01）、更低的再治疗率（比值比=0.18；95%置信区间，0.05 - 0.07；P = 0.010）、更高的卒中相关并发症（比值比=1.66，95%置信区间，1.16 - 2.37；P = 0.005）以及更高的出血相关并发症（比值比=1.98；95%置信区间，1.22 - 13.21；P = 0.005）。在术中并发症、狭窄相关并发症、死亡率、良好结局以及研究结束时的完全闭塞方面，两者无显著差异。
尚未进行比较PEDC和PED的随机对照试验。鉴于所有纳入研究均为观察性研究，患者的基线特征并未完全均衡。
本荟萃分析研究表明，PEDC治疗大型颅内动脉瘤在6个月时可诱导更快的完全闭塞率和更低的再治疗率。然而，它增加了术后卒中相关并发症的风险，且本研究中发现的更快的动脉瘤完全闭塞率与长期动脉瘤或远端动脉破裂的减少并无关联。因此，本研究提示需要寻找更好的策略来改善大型颅内动脉瘤长期出血相关并发症。
