Clipping Versus Coiling for Ruptured Intracranial Aneurysms A Systematic Review and Meta-Analysis
Clipping Versus Coiling for Ruptured Intracranial Aneurysms A Systematic Review and Meta-Analysis
复制标题
颅内动脉瘤破裂的夹闭与盘绕的系统评价和荟萃分析
DOI：
10.1161/strokeaha.112.663559
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发表时间：
2013-01-01
期刊：
影响因子：
8.3
通讯作者：
Peng, Ying
中科院分区：
文献类型：
--
作者：
Li, Hui;Pan, Rui;Peng, Ying
背景和目的——血管内治疗越来越多地用于治疗动脉瘤性蛛网膜下腔出血。本分析的目的是评估有关夹闭与弹簧圈比较的安全性和效率的当前证据。方法 - 我们对 1999 年 1 月至 2012 年 7 月期间夹闭与弹簧圈比较的研究进行了荟萃分析。使用比值比（OR；夹子与弹簧圈）描述治疗组之间二元结果的比较。结果 - 纳入了 4 项随机对照试验和 23 项观察性研究。随机对照试验表明，弹簧圈降低了 1 年不良结果发生率（OR，1.48；95% 置信区间 [CI]，1.24-1.76）。然而，非随机对照试验中不存在统计学差异（OR，1.11；95% CI，0.96-1.28）。亚组分析显示，与术前等级较差的患者（OR，0.88；95% CI 0.56-1.38）相比，弹簧圈对术前等级良好的患者（OR，1.51；95% CI，1.24-1.84）产生更好的结果。此外，弹簧圈栓塞后再出血的发生率较高（OR，0.43；95% CI，0.28-0.66），相应于夹闭的完全闭塞率更高（OR，2.43；95% CI，1.88-3.13）。 1 年死亡率无显着差异（OR，1.07；95% CI，0.88-1.30）。夹闭后血管痉挛更为常见（OR，1.43；95% CI，1.07-1.91），而缺血性梗塞（OR，0.74；95% CI，0.52-1.06）、分流依赖性脑积水（OR，0.84；95% CI，0.66-1.07）和手术治疗更常见。并发症发生率（OR，1.19；95% CI，0.67-2.11）在不同技术之间没有显着差异。结论——弹簧圈弹簧圈产生更好的临床结果，术前分级良好的患者比术前分级差的患者获益更大。然而，盘绕会导致再出血的风险更大。需要精心设计的随机试验，并对此方面进行特殊考虑。 （中风。2013；44：29-37。）
Background and Purpose-Endovascular treatment has increasingly been used for aneurismal subarachnoid aneurismal hemorrhage. The aim of this analysis is to assess the current evidence regarding safety and efficiency of clipping compared with coiling.Methods-We conducted a meta-analysis of studies that compared clipping with coiling between January 1999 and July 2012. Comparison of binary outcomes between treatment groups was described using odds ratios (OR; clip versus coil).Results-Four randomized controlled trials and 23 observational studies were included. Randomized controlled trials showed that coiling reduced the 1-year unfavorable outcome rate (OR, 1.48; 95% confidence interval [CI], 1.24-1.76). However, there was no statistical deference in nonrandomized controlled trials (OR, 1.11; 95% CI, 0.96-1.28). Subgroup analysis revealed coiling yielded better outcomes for patients with good preoperative grade (OR, 1.51; 95% CI, 1.24-1.84) than for poor preoperative patients (OR, 0.88; 95% CI 0.56-1.38). Additionally, the incidence of rebleeding is higher after coiling (OR, 0.43; 95% CI, 0.28-0.66), corresponding to a better complete occlusion rate of clipping (OR, 2.43; 95% CI, 1.88-3.13). The 1-year mortality showed no significant difference (OR, 1.07; 95% CI, 0.88-1.30). Vasospasm was more common after clipping (OR, 1.43; 95% CI, 1.07-1.91), whereas the ischemic infarct (OR, 0.74; 95% CI, 0.52-1.06), shunt-dependent hydrocephalus (OR, 0.84; 95% CI, 0.66-1.07), and procedural complication rates (OR, 1.19; 95% CI, 0.67-2.11) did not differ significantly between techniques.Conclusions-Coiling yields a better clinical outcome, the benefit being greater in those with a good preoperative grade than those with a poor preoperative grade. However, coiling leads to a greater risk of rebleeding. Well-designed randomized trials with special considerations to the aspect are needed. (Stroke. 2013;44:29-37.)