Ma Yu-Hu, He Yong-Lin, Zhang Xiao-Yue, Shang Rui, Hu Hai-Tao, Wang Ting, Lin Sen, Pan Ya-Wen, Zhang Chang-Wei
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Neurosurgery, The Second Hospital of Lanzhou University, Lanzhou, China.
Transl Stroke Res. 2024 Dec 4. doi: 10.1007/s12975-024-01314-0.
To systematically evaluate the safety and efficacy of SAC compared to non-SAC in the treatment of RIA, integrating evidence from high-quality studies to guide clinical practice.
A meta-analysis was conducted to compare SAC with coiling alone and BAC in the treatment of RIA. Primary outcomes were immediate and follow-up aneurysm occlusion rates, along with perioperative hemorrhagic and ischemic complication rates.
A total of thirteen retrospective cohort studies were included, comprising 3,086 patients, with 1,078 in the SAC group and 2,008 in the non-SAC group. The immediate complete occlusion rates were similar between the SAC and non-SAC groups (59.1% vs. 61.4%; RR = 1.00; 95% CI [0.94, 1.07]; p = 0.92). However, the SAC group demonstrated a significantly higher long-term complete occlusion rate (61.3% vs. 40.6%; RR = 1.44; 95% CI [1.22, 1.69]; p < 0.001). The incidence of ischemic complications was greater in the SAC group (12.2% vs. 10.0%; RR = 1.68; 95% CI [1.37, 2.07]; p < 0.001), as was the incidence of hemorrhagic complications (7.3% vs. 5.1%; RR = 1.55; 95% CI [1.15, 2.08]; p = 0.004). Perioperative mortality was also elevated in the SAC group (6.7% vs. 6.8%; RR = 1.37; 95% CI [1.00, 1.88]; p = 0.048), with a non-significant trend towards higher long-term mortality (9.8% vs. 9.2%; RR = 1.35; 95% CI [0.98, 1.87]; p = 0.068). Functional outcomes at discharge (76.0% vs. 71.0%; RR = 0.97; 95% CI [0.92, 1.02]; p = 0.237), six months (57.8% vs. 60.8%; RR = 0.93; 95% CI [0.81, 1.07]; p = 0.296), and at the last follow-up (RR = 1.01; 95% CI [0.97, 1.06]; p = 0.592) were comparable between the two groups.
SAC significantly improves long-term occlusion rates for RIA compared to non-SAC, despite a higher incidence of complications. Careful patient selection and optimization of antiplatelet therapy may enhance the safety and efficacy of SAC for RIA treatment.
与非弹簧圈辅助栓塞（SAC）相比，系统评价SAC治疗破裂颅内动脉瘤（RIA）的安全性和有效性，整合高质量研究证据以指导临床实践。
进行一项荟萃分析，比较SAC与单纯弹簧圈栓塞及球囊辅助弹簧圈栓塞治疗RIA的效果。主要结局指标为即刻及随访时动脉瘤闭塞率，以及围手术期出血和缺血性并发症发生率。
共纳入13项回顾性队列研究，包括3086例患者，其中SAC组1078例，非SAC组2008例。SAC组与非SAC组的即刻完全闭塞率相似（59.1%对61.4%；相对危险度[RR]=1.00；95%可信区间[CI][0.94,1.07]；P=0.92）。然而，SAC组的长期完全闭塞率显著更高（61.3%对40.6%；RR=1.44；95%CI[1.22,1.69]；P<0.001）。SAC组的缺血性并发症发生率更高（12.2%对10.0%；RR=1.68；95%CI[1.37,2.07]；P<0.001），出血性并发症发生率亦更高（7.3%对5.1%；RR=1.55；95%CI[1.15,2.08]；P=0.004）。SAC组的围手术期死亡率也有所升高（6.7%对6.8%；RR=1.37；95%CI[1.00,1.88]；P=0.048），长期死亡率有升高趋势但无统计学意义（9.8%对9.2%；RR=1.35；95%CI[0.98,1.87]；P=0.068）。两组出院时（76.0%对71.0%；RR=0.97；95%CI[0.92,1.02]；P=0.237）、6个月时（57.8%对60.8%；RR=0.93；95%CI[0.81,1.07]；P=0.296）及末次随访时（RR=1.01；95%CI[0.97,1.06]；P=0.592）的功能结局相当。
与非SAC相比，SAC显著提高RIA的长期闭塞率，尽管并发症发生率更高。谨慎选择患者并优化抗血小板治疗可能会提高SAC治疗RIA的安全性和有效性。
