Ocílio Ribeiro Gonçalves, Anderson Matheus Pereira da SIlva, Mariana Lee Han, Filipe Virgilio Ribeiro, Mariana Oliveira, Rafael Reis de Oliveira, Milene Vitória Sampaio Sobral, Ahmet Gunkan, Marcio Yuri Ferreira, Jhon E Bocanegra-Becerra, Christian Ferreira, David Gordon, Yafell Serulle, David Langer
{"title":"支架辅助线圈栓塞与颅内椎动脉夹层动脉瘤分流：系统回顾和荟萃分析。","authors":"Ocílio Ribeiro Gonçalves, Anderson Matheus Pereira da SIlva, Mariana Lee Han, Filipe Virgilio Ribeiro, Mariana Oliveira, Rafael Reis de Oliveira, Milene Vitória Sampaio Sobral, Ahmet Gunkan, Marcio Yuri Ferreira, Jhon E Bocanegra-Becerra, Christian Ferreira, David Gordon, Yafell Serulle, David Langer","doi":"10.1007/s00234-025-03739-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial vertebral artery dissecting aneurysms (IVADAs) represent a rare but challenging condition associated with high morbidity and mortality. In the therapeutic landscape, endovascular interventions such as Flow Diversion (FD) and Stent-Assisted Coiling (SAC) are widely used for the management of IVADAs. The aim of this systematic review and meta-analysis is to compare the clinical outcomes and complications associated with FD and SAC techniques in the endovascular management of IVADAs.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Web of Science and Scopus from inception to December 2024. This meta-analysis included retrospective cohort studies comparing flow diverters versus stent-assisted coiling in patients with IVADAs. The primary outcomes included in-stent stenosis, complete occlusion rates, and modified Rankin Scale (mRS) scores. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies. Statistical analyses were conducted using R software (version 4.4.0), with risk ratios (RR) and 95% confidence intervals (CI) calculated using the Mantel-Haenszel method. Heterogeneity was assessed using Cochran's Q test and I<sup>2</sup> statistics, with an I<sup>2</sup> > 40% considered significant. A leave-one-out analysis was performed to evaluate the influence of individual studies on the pooled estimates.</p><p><strong>Results: </strong>A total of seven non-randomized studies were included in the meta-analysis comprising 649 patients with IVADAs. Long-term complete occlusion rates were similar between FD and SAC (RR 0.99; 95% CI 0.89-1.10; I<sup>2</sup> = 0%). Favorable functional outcomes were marginally higher with FD (RR 1.04; 95% CI 1.00-1.10; I<sup>2</sup> = 0%). Recurrence (RR 0.36; 95% CI 0.13-1.01; I<sup>2</sup> = 0%) and retreatment rates (RR 0.44; 95% CI 0.16-1.17; I<sup>2</sup> = 0%) were not significantly different between groups. In terms of safety outcomes, in-stent stenosis rates (RR 1.17; 95% CI 0.47-2.91; I<sup>2</sup> = 0%) and complication rates (RR 0.74; 95% CI 0.40-1.35; I<sup>2</sup> = 0%) were not statistically significantly different. Risk of bias assessment indicated an overall moderate risk across studies, with no study classified as having a serious risk of bias.</p><p><strong>Conclusion: </strong>In this meta-analysis, FD and SAC demonstrated comparable efficacy and safety profiles in the treatment of IVADAs, with no significant differences in long-term complete occlusion, recurrence, retreatment, in-stent stenosis, or complication rates. In this context, FD is a promising technique to treat IVADAs.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Stent-Assisted Coil Embolization Versus Flow Diversion in Intracranial Vertebral Artery Dissecting Aneurysms: A Systematic Review and Meta-Analysis.\",\"authors\":\"Ocílio Ribeiro Gonçalves, Anderson Matheus Pereira da SIlva, Mariana Lee Han, Filipe Virgilio Ribeiro, Mariana Oliveira, Rafael Reis de Oliveira, Milene Vitória Sampaio Sobral, Ahmet Gunkan, Marcio Yuri Ferreira, Jhon E Bocanegra-Becerra, Christian Ferreira, David Gordon, Yafell Serulle, David Langer\",\"doi\":\"10.1007/s00234-025-03739-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Intracranial vertebral artery dissecting aneurysms (IVADAs) represent a rare but challenging condition associated with high morbidity and mortality. In the therapeutic landscape, endovascular interventions such as Flow Diversion (FD) and Stent-Assisted Coiling (SAC) are widely used for the management of IVADAs. The aim of this systematic review and meta-analysis is to compare the clinical outcomes and complications associated with FD and SAC techniques in the endovascular management of IVADAs.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Web of Science and Scopus from inception to December 2024. This meta-analysis included retrospective cohort studies comparing flow diverters versus stent-assisted coiling in patients with IVADAs. The primary outcomes included in-stent stenosis, complete occlusion rates, and modified Rankin Scale (mRS) scores. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies. Statistical analyses were conducted using R software (version 4.4.0), with risk ratios (RR) and 95% confidence intervals (CI) calculated using the Mantel-Haenszel method. Heterogeneity was assessed using Cochran's Q test and I<sup>2</sup> statistics, with an I<sup>2</sup> > 40% considered significant. A leave-one-out analysis was performed to evaluate the influence of individual studies on the pooled estimates.</p><p><strong>Results: </strong>A total of seven non-randomized studies were included in the meta-analysis comprising 649 patients with IVADAs. Long-term complete occlusion rates were similar between FD and SAC (RR 0.99; 95% CI 0.89-1.10; I<sup>2</sup> = 0%). Favorable functional outcomes were marginally higher with FD (RR 1.04; 95% CI 1.00-1.10; I<sup>2</sup> = 0%). Recurrence (RR 0.36; 95% CI 0.13-1.01; I<sup>2</sup> = 0%) and retreatment rates (RR 0.44; 95% CI 0.16-1.17; I<sup>2</sup> = 0%) were not significantly different between groups. In terms of safety outcomes, in-stent stenosis rates (RR 1.17; 95% CI 0.47-2.91; I<sup>2</sup> = 0%) and complication rates (RR 0.74; 95% CI 0.40-1.35; I<sup>2</sup> = 0%) were not statistically significantly different. Risk of bias assessment indicated an overall moderate risk across studies, with no study classified as having a serious risk of bias.</p><p><strong>Conclusion: </strong>In this meta-analysis, FD and SAC demonstrated comparable efficacy and safety profiles in the treatment of IVADAs, with no significant differences in long-term complete occlusion, recurrence, retreatment, in-stent stenosis, or complication rates. In this context, FD is a promising technique to treat IVADAs.</p>\",\"PeriodicalId\":19422,\"journal\":{\"name\":\"Neuroradiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-09-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neuroradiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00234-025-03739-2\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuroradiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00234-025-03739-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
颅内椎动脉夹层动脉瘤（IVADAs）是一种罕见但具有挑战性的疾病，具有高发病率和死亡率。在治疗领域，血管内干预如血流转移（FD）和支架辅助盘绕（SAC）被广泛用于IVADAs的治疗。本系统综述和荟萃分析的目的是比较FD和SAC技术在IVADAs血管内治疗中的临床结果和并发症。方法：系统检索PubMed、Embase、Web of Science和Scopus数据库，检索时间自成立至2024年12月。该荟萃分析纳入了回顾性队列研究，比较了IVADAs患者的分流器与支架辅助盘绕。主要结果包括支架内狭窄、完全闭塞率和改良Rankin量表（mRS）评分。对非随机研究使用ROBINS-I工具评估偏倚风险。采用R软件（版本4.4.0）进行统计分析，采用Mantel-Haenszel方法计算风险比（RR）和95%置信区间（CI）。异质性评估采用Cochran’s Q检验和I2统计，I2 bb0 40%认为显著。进行留一分析以评估个别研究对汇总估计的影响。结果：荟萃分析共纳入7项非随机研究，包括649例IVADAs患者。FD和SAC的长期完全闭塞率相似（RR 0.99; 95% CI 0.89-1.10; I2 = 0%）。FD患者良好的功能结局略高（RR 1.04; 95% CI 1.00-1.10; I2 = 0%）。复发率（RR 0.36; 95% CI 0.13-1.01; I2 = 0%）和复治率（RR 0.44; 95% CI 0.16-1.17; I2 = 0%）组间差异无统计学意义。在安全性结局方面，支架内狭窄率（RR 1.17; 95% CI 0.47-2.91; I2 = 0%）和并发症发生率（RR 0.74; 95% CI 0.40-1.35; I2 = 0%）差异无统计学意义。偏倚风险评估显示，所有研究的总体偏倚风险为中等，没有研究被归类为具有严重偏倚风险。结论：在这项荟萃分析中，FD和SAC在治疗IVADAs方面表现出相当的疗效和安全性，在长期完全闭塞、复发、再治疗、支架内狭窄或并发症发生率方面没有显著差异。在这种情况下，FD是一种很有前途的治疗IVADAs的技术。
Stent-Assisted Coil Embolization Versus Flow Diversion in Intracranial Vertebral Artery Dissecting Aneurysms: A Systematic Review and Meta-Analysis.
Introduction: Intracranial vertebral artery dissecting aneurysms (IVADAs) represent a rare but challenging condition associated with high morbidity and mortality. In the therapeutic landscape, endovascular interventions such as Flow Diversion (FD) and Stent-Assisted Coiling (SAC) are widely used for the management of IVADAs. The aim of this systematic review and meta-analysis is to compare the clinical outcomes and complications associated with FD and SAC techniques in the endovascular management of IVADAs.
Methods: We systematically searched PubMed, Embase, Web of Science and Scopus from inception to December 2024. This meta-analysis included retrospective cohort studies comparing flow diverters versus stent-assisted coiling in patients with IVADAs. The primary outcomes included in-stent stenosis, complete occlusion rates, and modified Rankin Scale (mRS) scores. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies. Statistical analyses were conducted using R software (version 4.4.0), with risk ratios (RR) and 95% confidence intervals (CI) calculated using the Mantel-Haenszel method. Heterogeneity was assessed using Cochran's Q test and I2 statistics, with an I2 > 40% considered significant. A leave-one-out analysis was performed to evaluate the influence of individual studies on the pooled estimates.
Results: A total of seven non-randomized studies were included in the meta-analysis comprising 649 patients with IVADAs. Long-term complete occlusion rates were similar between FD and SAC (RR 0.99; 95% CI 0.89-1.10; I2 = 0%). Favorable functional outcomes were marginally higher with FD (RR 1.04; 95% CI 1.00-1.10; I2 = 0%). Recurrence (RR 0.36; 95% CI 0.13-1.01; I2 = 0%) and retreatment rates (RR 0.44; 95% CI 0.16-1.17; I2 = 0%) were not significantly different between groups. In terms of safety outcomes, in-stent stenosis rates (RR 1.17; 95% CI 0.47-2.91; I2 = 0%) and complication rates (RR 0.74; 95% CI 0.40-1.35; I2 = 0%) were not statistically significantly different. Risk of bias assessment indicated an overall moderate risk across studies, with no study classified as having a serious risk of bias.
Conclusion: In this meta-analysis, FD and SAC demonstrated comparable efficacy and safety profiles in the treatment of IVADAs, with no significant differences in long-term complete occlusion, recurrence, retreatment, in-stent stenosis, or complication rates. In this context, FD is a promising technique to treat IVADAs.
期刊介绍：
Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
