单纯支架置入术与支架辅助弹簧圈栓塞术治疗后循环夹层动脉瘤的系统评价和Meta分析

Sole Stenting versus Stent-Assisted Coiling for Treating Dissecting Posterior Circulation Aneurysms: A Systematic Review and Meta-Analysis.

作者信息

Prestes Milena Zadra, Oliveira Leonardo B, Soares Cid, Ramos de Souza Jefferson, Geris da Costa José, Rabelo Nicollas Nunes, Batista Sávio, Bertani Raphael, Welling Leonardo C, Pinheiro Agostinho C, Patel Nirav J, Figueiredo Eberval G

机构信息

Department of Medicine, State University of Ponta Grossa, Ponta Grossa, Brazil.

出版信息

World Neurosurg. 2024 Dec;192:201-211.e9. doi: 10.1016/j.wneu.2024.09.020. Epub 2024 Sep 11.

DOI:10.1016/j.wneu.2024.09.020

PMID:39270787

Abstract

BACKGROUND

Among the reconstructive methods for treating dissecting posterior circulation aneurysms, there are stent-assisted coiling (SAC), and sole stenting (SS) therapy. Despite SAC being widely employed when compared to SS, no study systematically analyzed the difference in their outcomes.

METHODS

The authors conducted a meta-analysis of studies employing both therapies to compare their outcomes. A search was performed in January 2024, including only studies with consecutive patients submitted to SS or SAC. The studies had to have at least one of the following outcomes: complete aneurysm occlusion, complications, mortality, aneurysm recurrence, retreatment, and good clinical outcome. Odds ratio (OR) with 95% confidence interval (CI) were utilized for statistics.

RESULTS

In a pooled analysis of 17 studies, comparing 173 SS and 377 SAC procedures for dissecting posterior circulation aneurysms, no significant differences were found in related mortality (OR 1.44; 95% CI 0.49-4.27); total mortality (OR 1.33; 95% CI 0.53-3.37); retreatment (OR 0.45; 95% CI 0.16-1.26); recurrence (OR 1.00; 95% CI 0.43-2.33); postoperative complete aneurysmal occlusion (OR 0.79; 95% CI 0.09-6.77); follow-up complete aneurysmal occlusion (OR 1.57; 95% CI 0.62-3.94); intraoperative complications (OR 1.04; 95% CI 0.29-3.73); postoperative complications (OR 1.22; 95% CI 0.61-2.45); hemorrhagic complications (OR 2.16; 95% CI 0.77-6.06); ischemic complications (OR 1.68; 95% CI 0.68-4.15). Good clinical outcomes significantly favored SAC (OR 0.45; 95% CI 0.23-0.86).

CONCLUSIONS

The findings suggest there is no substantial basis for favoring SAC over SS across all cases. Instead, an individualized approach should be considered, according to the patient's characteristics, surgeon skills, and the available material.

摘要

背景

在治疗后循环夹层动脉瘤的重建方法中，有支架辅助弹簧圈栓塞术（SAC）和单纯支架置入术（SS）。尽管与SS相比，SAC被广泛应用，但尚无研究系统分析它们在治疗效果上的差异。

方法

作者对采用这两种治疗方法的研究进行了荟萃分析，以比较它们的治疗效果。于2024年1月进行检索，仅纳入连续接受SS或SAC治疗患者的研究。这些研究必须至少有以下一项结果：动脉瘤完全闭塞、并发症、死亡率、动脉瘤复发、再次治疗以及良好的临床结局。采用比值比（OR）及95%置信区间（CI）进行统计学分析。

结果

在对17项研究的汇总分析中，比较了173例SS和377例SAC治疗后循环夹层动脉瘤的手术，发现相关死亡率（OR 1.44；95% CI 0.49 - 4.27）、总死亡率（OR 1.33；95% CI 0.53 - 3.37）、再次治疗（OR 0.45；95% CI 0.16 - 1.26）、复发（OR 1.00；95% CI 0.43 - 2.33）、术后动脉瘤完全闭塞（OR 0.79；95% CI 0.09 - 6.77）、随访期动脉瘤完全闭塞（OR 1.57；95% CI 0.62 - 3.94）、术中并发症（OR 1.04；95% CI 0.29 - 3.73）、术后并发症（OR 1.22；95% CI 0.61 - 2.45）、出血性并发症（OR 2.16；95% CI 0.77 - 6.06）、缺血性并发症（OR 1.68；95% CI 0.68 - 4.15）方面均无显著差异。良好的临床结局显著有利于SAC（OR 0.45；95% CI 0.23 - 0.86）。