Table3_Diffusion-weighted imaging lesions after endovascular treatment of cerebral aneurysms: A network meta-analysis.docx

BackgroundThromboembolism is one of the common complications in endovascular treatments including coiling alone, stent-assisted coiling (SAC), balloon-assisted coiling (BAC), and flow-diverting (FD) stents. Such treatments are widely used in intracranial aneurysms (IAs), which usually present as positive lesions in diffusion-weighted imaging (DWI). Whether these adjunctive techniques increase postprocedural DWI-positive lesions after endovascular treatment remains unclear.
MethodsA thorough electronic search for the literature published in English between January 2000 and October 2022 was conducted on PubMed, Medline, and EMBASE. Eighteen studies (3 cohort studies and 15 case–control studies) involving 1,843 patients with unruptured IAs (UIAs) were included. We performed a frequentist framework network meta-analysis (NMA) to compare the rank risks of cerebral thromboembolism of the above four endovascular treatments. The incoherence test was used to analyze the statistical disagreement between direct and indirect evidence. Funnel plots were used to analyze publication bias.
ResultsThe incidences of DWI lesions in patients who received FD stents, SAC, BAC, and coiling alone were 66.1% (109/165), 37.6% (299/795), 31.1% (236/759), and 25.6% (236/921). The incidence of DWI lesions in patients who received FD stents was higher than that in patients who received SAC [OR: 2.40; 95% CI (1.15, 5.00), P < 0.05], BAC [OR: 2.62; 95% CI (1.19, 5.77), P < 0.05], or coiling alone [OR: 2.77; 95% CI (1.26, 6.07), P < 0.05]. The incoherence test showed preferable consistency in this NMA. No obvious publication bias was found in the funnel plot.
ConclusionFD stent placement brings more ischemic lesions identified by DWI than any other procedures for patients with UIA. The characteristics of FD stents may result in a high incidence of DWI lesions.

【背景】血栓栓塞是单纯弹簧圈栓塞、支架辅助弹簧圈栓塞（stent-assisted coiling, SAC）、球囊辅助弹簧圈栓塞（balloon-assisted coiling, BAC）以及血流导向支架（flow-diverting stent, FD）等血管内治疗的常见并发症之一。此类治疗手段广泛应用于颅内动脉瘤（intracranial aneurysm, IA）患者，此类病灶通常在弥散加权成像（diffusion-weighted imaging, DWI）上表现为阳性信号。目前尚不清楚上述辅助技术是否会增加血管内治疗术后DWI阳性病灶的发生率。【方法】本研究于PubMed、Medline及EMBASE数据库中系统检索2000年1月至2022年10月期间发表的英文文献。最终纳入18项研究，包含3项队列研究与15项病例对照研究，共涉及1843例未破裂颅内动脉瘤（unruptured intracranial aneurysm, UIA）患者。本研究采用频率论框架下的网络meta分析（network meta-analysis, NMA），对比上述四种血管内治疗术式的脑血栓栓塞秩风险。采用不一致性检验分析直接证据与间接证据间的统计学异质性，通过漏斗图分析发表偏倚。【结果】接受血流导向支架、支架辅助弹簧圈栓塞、球囊辅助弹簧圈栓塞及单纯弹簧圈栓塞的患者，其DWI病灶发生率分别为66.1%（109/165）、37.6%（299/795）、31.1%（236/759）及25.6%（236/921）。接受血流导向支架治疗的患者，其DWI病灶发生率显著高于支架辅助弹簧圈栓塞组[比值比（odds ratio, OR）=2.40；95%置信区间（confidence interval, CI）：1.15~5.00，P<0.05]、球囊辅助弹簧圈栓塞组[OR=2.62；95%CI：1.19~5.77，P<0.05]及单纯弹簧圈栓塞组[OR=2.77；95%CI：1.26~6.07，P<0.05]。不一致性检验结果显示，本网络meta分析具有良好的一致性。漏斗图分析未发现明显发表偏倚。【结论】对于未破裂颅内动脉瘤患者，血流导向支架置入术相较于其他三种术式，可导致更多经DWI检出的缺血性病灶。血流导向支架的自身特性可能是其DWI病灶发生率较高的原因。