Tang Kai, Liu Xiao-Meng, Zhang Chao, Ma Shuang-Ju, Song Xiao-Lei, Du Hai-Long, Hu Yu-Hua, Wu Jian-Liang
Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, P.R. China.
J Craniofac Surg. 2025;36(5):1502-1508. doi: 10.1097/SCS.0000000000010998. Epub 2024 Dec 27.
The stent-assisted coiling (SAC) and flow-diverter stent (FDS) techniques are widely used in the endovascular treatment of paraclinoid aneurysms. This article compares the occlusion rate, periprocedural complications, and clinical outcomes of SAC and FDSs.
Between January 2010 and December 2020, a systematic search of electronic databases identified 2283 articles for screening. After the application of inclusion and exclusion criteria, data were extracted for a meta-analysis of the proportions.
Of 23 articles containing 4 comparative studies, 27 cohorts were included, and 1208 patients with 1328 aneurysms were analyzed: In 10 cohorts, 381 (28.7%) patients were treated with SAC, whereas in 17 cohorts, 947 (71.3%) patients were treated with FDSs. In the comparative studies, no significance was observed between the 2 treatments. In the pooled cohorts, complete occlusion was achieved in 85% of aneurysms after treatment with FDSs (95% CI: 0.81-0.88, I2 =34.7%) and 76% after treatment with SAC (95% CI: 0.70-0.81, I2 =16.6%); the subgroup analysis was statistically significant ( P =0.003). New visual complications were observed in 5% of the FDS-treated group (95% CI: 0.02-0.09, I2 =76.9%) and in 1% of the SAC-treated group (95% CI: 0.00-0.02, I2 =0%); the subgroup analysis was statistically significant ( P =0.018). Other observational indices, including total procedure-related complications; hemorrhagic, thrombotic, and ischemic complications; permanent morbidities, and favorable neurological outcomes, showed no statistical significance between the groups.
Compared with SAC, treatment with FDSs may have a higher complete occlusion rate at follow-up. The similarly low rates for procedure-related complications and permanent morbidities indicate that both treatments are safe. A higher rate of new visual complications was noted in the FDS-treated group. Further research is required for direct comparisons along with a complete ophthalmological examination.
支架辅助弹簧圈栓塞术（SAC）和血流导向支架（FDS）技术广泛应用于床突旁动脉瘤的血管内治疗。本文比较了SAC和FDS的闭塞率、围手术期并发症及临床结局。
2010年1月至2020年12月，通过系统检索电子数据库共筛选出2283篇文章。应用纳入和排除标准后，提取数据进行比例的荟萃分析。
在23篇包含4项比较研究的文章中，纳入了27个队列，分析了1208例患者的1328个动脉瘤：在10个队列中，381例（28.7%）患者接受了SAC治疗，而在17个队列中，947例（71.3%）患者接受了FDS治疗。在比较研究中，两种治疗方法之间未观察到显著性差异。在汇总队列中，FDS治疗后85%的动脉瘤实现了完全闭塞（95%CI：0.81-0.88，I2=34.7%），SAC治疗后为76%（95%CI：0.70-0.81，I2=16.6%）；亚组分析具有统计学显著性（P=0.003）。FDS治疗组有5%出现了新的视觉并发症（95%CI：0.02-0.09，I2=76.9%），SAC治疗组为1%（95%CI：0.00-0.02，I2=0%）；亚组分析具有统计学显著性（P=0.018）。其他观察指标，包括总的手术相关并发症、出血、血栓形成和缺血性并发症、永久性致残率以及良好的神经学结局，两组之间均无统计学显著性差异。
与SAC相比，FDS治疗在随访时可能具有更高的完全闭塞率。手术相关并发症和永久性致残率同样较低，表明两种治疗方法均安全。FDS治疗组新视觉并发症的发生率更高。需要进一步研究进行直接比较并进行全面的眼科检查。
