血流导向装置和弹簧圈栓塞对颅内动脉瘤影响的Meta分析

目的通过meta分析的方法,比较血流导向装置(FDD)和弹簧圈栓塞治疗(CET)对颅内动脉瘤的临床疗效和安全性。方法系统检索Pub Med、Cochrane图书馆、Embase、中国知网和万方数据库,并手工查阅相关文献的引文目录。检索时间截至2017年3月,纳入符合入选标准的研究。疗效终点包括动脉瘤完全闭塞率和复发率,安全性终点为并发症发生率。结果最终纳入临床研究14项,包括观察性研究13项和随机对照试验1项。总样本量为1234例,其中FDD组449例,CET组785例。Meta分析结果提示,与CET相比,FDD能明显提高动脉瘤完全闭塞率(OR:3.40,95%CI:2.54~4.55;P0.01)并降低术后复发率(OR:0.12,95%CI:0.06~0.24;P0.01)。两组患者的总体并发症发生率并无显著差异(OR:1.11,95%CI:0.64~1.93;P=0.72)。结论相比于CET,FDD治疗颅内动脉瘤的效果更佳,且不增加并发症的发生率。

Clinical effect of flow diversion device versus coil embolization in treatment of intracranial aneurysm: a meta-analysis

Objective To investigate the clinical effect and safety of flow diversion device (FDD) versus coil embolization therapy (CET) in the treatment of intracranial aneurysm through a meta-analysis.Methods PubMed, Cochrane Library, Embase, CNKI, and Wanfang Data were searched for studies which were published up to March 2017 and met the inclusion criteria, and the reference lists of related articles were checked manually. The efficacy endpoints were complete occlusion rate and recurrence rate of intracranial aneurysm, and the safety endpoint was the incidence rate of complications.Results A total of 14 clinical studies were included, i.e., 13 observational studies and 1 randomized controlled trial. There were 1234 patients in total, with 449 in the FDD group and 785 in the CET group. The meta-analysis showed that compared with CET, FDD significantly increased the complete occlusion rate of intracranial aneurysm (odds ratio [OR]=3.40, 95% confidence interval [CI]: 2.54-4.55, P<0.01) and reduced postoperative recurrence rate (OR=0.12, 95%CI: 0.06-0.24, P<0.01). There was no significant difference in the incidence rate of complications between the two groups (OR=1.11, 95%CI: 0.64-1.93, P=0.72).Conclusions Compared with CET, FDD shows a better clinical effect in the treatment of intracranial aneurysm and does not increase the incidence rate of complications.