可膨胀水凝胶弹簧线圈与裸铂弹簧线圈栓塞颅内动脉瘤有效性及安全性的Meta分析

doi:10.3877/cma.j.issn.2095-9141.2019.02.003

目的

比较可膨胀水凝胶弹簧线圈与裸铂弹簧线圈治疗颅内动脉瘤的有效性及安全性。

方法

系统检索Pubmed、Embase、Web of Science、Cochrane图书馆、中国知网及万方数据库自建库至2018年11月收录的关于使用水凝胶弹簧圈及裸铂弹簧圈治疗颅内动脉瘤的文献。制定文献的纳入与排除标准，筛选符合纳入标准的文献。采用RevMan5.3软件进行Meta分析。

结果

共纳入4篇文献，均为英文文献，样本量为1526例。Meta分析的结果表明，水凝胶线圈和裸铂线圈在术中完全栓塞动脉瘤（OR=0.89，95%CI：0.67~1.17，P=0.39）、术后18个月患者恢复情况（OR=1.35，95%CI：0.99~1.84，P=0.06）、所有并发症发生比例（OR=0.87，95%CI：0.69~1.10，P=0.25）方面差异均并无统计学意义，异质性较小（I²<50%，P>0.05）。

结论

同传统裸铂弹簧线圈相比，水凝胶弹簧线圈的有效性及安全性基本相同。

关键词: 水凝胶弹簧线圈, 裸铂弹簧线圈, 颅内动脉瘤, Meta分析

Objective

To compare the efficacy and safety of hydrogel coils and bare platinum coils in the treatment of intracranial aneurysms by a Meta analysis.

Methods

Systematic retrieval of literature on the use of hydrogel coils and bare platinum coils in the treatment of intracranial aneurysms from the Pubmed, Embase, Web of Science, Cochrane Library, CNKI and Wanfang data from initiation of the databases to November 2018. The included studies were screened out strictly based on the criterion of inclusinon and exclusion. Revman 5.3 was used for Meta analysis.

Results

A total of 4 literature were included, all in English, with a sample of 1526 cases. The results of Meta analysis showed that there was no significant difference between hydrogel coil and bare platinum coil in embolization of aneurysms (OR=0.89, 95%CI: 0.67-1.17, P=0.39), recovery of patients 18 months after operation (OR=1.35, 95%CI: 0.99-1.84, P=0.06), and incidence of all complications (OR=0.87, 95%CI: 0.69-1.10, P=0.25), and with a relatively low heterogeneity (I²<50%, P>0.05).

Conclusion

Compared with bare platinum coils, hydrogel coils have similar efficacy and safety in in the treatment of intracranial aneurysms.

Key words: Hydrogel coils, Bare platinum coils, Intracranial aneurysms, Meta analysis

图1 文献筛选流程图

图2 纳入文献的质量评价情况

表1 纳入文献基本特征

作者	发表年份	例数		年龄		性别（男/女）		破裂/未破裂动脉瘤
作者	发表年份	水凝胶组	裸铂组	水凝胶组	裸铂组	水凝胶组	裸铂组	水凝胶组	裸铂组
White等^[5]	2011	249	250	51.0	51.0	73/176	76/174	139/110	138/112
Raymond等^[6]	2014	225	222	57.0±11.0	58.0±12.0	60/165	65/157	40/185	39/183
Poncyljusz等^[7]	2015	50	46	49.6±10.8	52.2±8.7	19/31	16/30	0/50	0/46
Taschner等^[8]	2016	243	241	52.9±12.6	54.1±11.8	71/172	80/161	103/140	105/136

表1 纳入文献基本特征

作者	发表年份	例数		年龄		性别（男/女）		破裂/未破裂动脉瘤
作者	发表年份	水凝胶组	裸铂组	水凝胶组	裸铂组	水凝胶组	裸铂组	水凝胶组	裸铂组
White等^[5]	2011	249	250	51.0	51.0	73/176	76/174	139/110	138/112
Raymond等^[6]	2014	225	222	57.0±11.0	58.0±12.0	60/165	65/157	40/185	39/183
Poncyljusz等^[7]	2015	50	46	49.6±10.8	52.2±8.7	19/31	16/30	0/50	0/46
Taschner等^[8]	2016	243	241	52.9±12.6	54.1±11.8	71/172	80/161	103/140	105/136

图3 线圈栓塞颅内动脉瘤的术后效果森林图

图4 线圈栓塞颅内动脉瘤术后18个月的影像学及恢复情况森林图

图5 线圈栓塞颅内动脉瘤术后并发症发生情况森林图

图6 残余动脉瘤瘤颈敏感性分析森林图

[1]	Molyneux A, Kerr R, Stratton I, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial[J]. Lancet, 2002, 360(9342): 1267-1274.
[2]	Raymond J, Molyneux AJ, Fox AJ, et al. The TEAM trial: safety and efficacy of endovascular treatment of unruptured intracranial aneurysms in the prevention of aneurysmal hemorrhages: a randomized comparison with indefinite deferral of treatment in 2002 patients followed for 10 years[J]. Trials, 2008, 9: 43.
[3]	Darsaut TE, Fahed R, Macdonald RL, et al. Surgical or endovascular management of ruptured intracranial aneurysms: an agreement study[J]. J Neurosurg, 2018, Epub ahead of print.
[4]	Kallmes DF, Fujiwara NH. New expandable hydrogel-platinum coil hybrid device for aneurysm embolization[J]. AJNR Am J Neuroradiol, 2002, 23(9): 1580-1588.
[5]	White PM, Lewis SC, Gholkar A, et al. Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial[J]. Lancet, 2011, 377(9778): 1655-1662.
[6]	Raymond J, Klink R, Chagnon M, et al. Patients prone to recurrence after endovascular treatment: periprocedural results of the PRET randomized trial on large and recurrent aneurysms[J]. AJNR Am J Neuroradiol, 2014, 35(9): 1667-1676.
[7]	Poncyljusz W, Zarzycki A, Zwarzany Ł, et al. Bare platinum coils vs. HydroCoil in the treatment of unruptured intracranial aneurysms-A single center randomized controlled study[J]. Eur J Radiol, 2015, 84(2): 261-265.
[8]	Taschner CA, Chapot R, Costalat V, et al. GREAT-a randomized controlled trial comparing HydroSoft/HydroFrame and bare platinum coils for endovascular aneurysm treatment: procedural safety and core-lab-assessedangiographic results[J]. Neuroradiology, 2016, 58(8): 777-786.
[9]	Brisman JL, Song JK, Newell DW. Cerebral aneurysms[J]. N Engl J Med, 2006, 355(9): 928-939.
[10]	UCAS Japan Investigators, Morita A, Kirino T, et al. The natural course of unruptured cerebral aneurysms in a Japanese cohort[J]. N Engl J Med, 2012, 366(26): 2474-2482.
[11]	Wiebers DO, Whisnant JP, Huston J, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment[J]. Lancet, 2003, 362(9378): 103-110.
[12]	Taschner CA, Thines L, El-Mahdy M, et al. GDC 360 degrees for the endovascular treatment of intracranial aneurysms: a matched-pair study analysing angiographic outcomes with GDC 3D Coils in 38 patients[J]. Neuroradiology, 2009, 51(1): 45-52.
[13]	Plowman RS, Clarke A, Clarke M, et al. Sixteen-year single-surgeon experience with coil embolization for ruptured intracranial aneurysms: recurrence rates and incidence of late rebleeding[J]. J Neurosurg, 2011, 114(3): 863-874.
[14]	Naggara ON, White PM, Guilbert F, et al. Endovascular treatment of intracranial unruptured aneurysms: systematic review and meta-analysis of the literature on safety and efficacy[J]. Radiology, 2010, 256(3): 887-897.
[15]	Satoh K, Matsubara S, Hondoh H, et al. Intracranial aneurysm embolization using interlocking detachable coils. Correlation between volume embolization rate and coil compaction[J]. Interv Neuroradiol, 1997, 3 Suppl 2: 125-128.
[16]	Tamatani S, Ito Y, Koike T, et al. Evaluation of the stability of intracranial aneurysms occluded with guglielmi detachable coils[J]. Interv Neuroradiol, 2001, 7(Suppl 1): 143-148.
[17]	Turner RD, da Costa LB, terBrugge KG. A multicenter registry of hydrocephalus following coil embolization of unruptured aneurysms: which patients are at risk and why it occurs[J]. J Neurointerv Surg, 2013, 5(3): 207-211.
[18]	Marchan EM, Sekula RF Jr, Ku A, et al. Hydrogel coil-related delayed hydrocephalus in patients with unruptured aneurysms[J]. J Neurosurg, 2008, 109(2): 186-190.
[19]	White PM, Raymond J. Endovascular coiling of cerebral aneurysms using "bioactive" or coated-coil technologies: a systematic review of the literature[J]. AJNR Am J Neuroradiol, 2009, 30(2): 219-226.
[20]	Broeders JA, Ahmed Ali U, Molyneux AJ, et al. Bioactive versus bare platinum coils for the endovascular treatment of intracranial aneurysms: systematic review and meta-analysis of randomized clinical trials[J]. J Neurointerv Surg, 2016, 8(9): 898-908.
[21]	Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test[J]. BMJ, 1997, 315(7109): 629-634.

[1]	蚁淳, 袁冬生, 熊学军. 系统免疫炎症指数与骨密度降低和骨质疏松的关联[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 609-617.
[2]	李志文, 李远志, 李华, 方志远. 糖皮质激素治疗膝骨关节炎疗效的网状Meta分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 484-496.
[3]	吴姗姗, 潘裕民, 刘晋, 张劲松, 乔莉. 睡眠呼吸暂停综合征患者静脉血栓栓塞症发生率的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 312-317.
[4]	程鹏, 杨道鸿, 邓文君, 钟宇琼, 胡晓雪, 黄小银, 周道扬. 纤维蛋白原治疗创伤性凝血病有效性和安全性的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(03): 225-231.
[5]	沈皓, 张驰, 韩旻轩, 陆晓庆, 周愉, 周莉丽. 骨皮质切开术对正畸治疗牙根吸收影响的Meta分析[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(03): 175-184.
[6]	郭仁凯, 武慧铭, 李辉宇. 机器人辅助全系膜切除术治疗右半结肠癌有效性和安全性的Meta分析及试验序贯分析[J/OL]. 中华普通外科学文献(电子版), 2024, 18(03): 234-240.
[7]	朱俊佳, 孙琦, 徐文龙, 陆天宇, 冯强, 储涛, 邢春根, 高春冬, 俞一峰, 赵振国. 永久性结肠造口预防性补片置入对预防造口旁疝价值的Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 336-342.
[8]	王招荐, 曹桢, 郭小双, 靳小雷, 刘子文. 加速康复外科理念应用于腹壁重建手术的系统评价及Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 343-350.
[9]	马振威, 宋润夫, 王兵. ERCP胆道内支架与骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌疗效的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 807-812.
[10]	龚财芳, 赵俊宇, 游川. 围手术期肠内营养在肝癌肝切除患者中有效性及安全性的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 551-556.
[11]	郁凯, 曾保起, 杨剑, 杨杰, 张殿英, 孙凤. 全关节镜与切开手术治疗肩袖撕裂疗效比较的系统综述与Meta分析[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 238-245.
[12]	冯铭, 孙洪涛. 动脉瘤性蛛网膜下腔出血的颅内压监测与管理[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(04): 248-253.
[13]	王芳, 刘达, 左智炜, 盛金平, 陈庭进, 蒋锐. 定量CT与双能X线骨密度仪对骨质疏松诊断效能比较的Meta分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 363-371.
[14]	周章明, 余水, 梁张. 老年破裂前循环动脉瘤患者的急诊显微手术治疗研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(02): 106-111.
[15]	周倩妹, 王宪娥, 徐筱, 老慧琳, 赵欣悦, 胡菁颖. 多元化系统护理对老年人群牙周健康指标影响的系统评价[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 500-506.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Hydrogel coils vs bare platinum coils in the treatment of intracranial aneurysms: a Meta analysis

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Hydrogel coils vs bare platinum coils in the treatment of intracranial aneurysms: a Meta analysis