• World Neurosurg · Aug 2019

    Review Meta Analysis Comparative Study

    Comparison of Flow Diversion and Coiling for the Treatment of Unruptured Intracranial Aneurysms.

    • Wen-Qiang Xin, Qi-Qiang Xin, Yan Yuan, Shi Chen, Xiang-Liang Gao, Yan Zhao, Hao Zhang, Wen-Kui Li, and Xin-Yu Yang.
    • Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.
    • World Neurosurg. 2019 Aug 1; 128: 464-472.

    BackgroundTo systematically assess the efficacy and safety between flow diversion and coiling for patients with unruptured intracranial aneurysms.MethodsPotential academic articles were identified from Cochrane Library, Medline, PubMed, EMBASE, ScienceDirect, and other databases. The time range we retrieved from was the inception of electronic databases to February 2019. Gray studies were identified from the references of included literature reports. STATA version 11.0 was used to analyze the pooled data.ResultsA total of 11 articles (10 retrospective studies and 1 prospective study) were involved in our study. The overall participants of the coiling group were 611, whereas 576 were in the flow diversion group. Our meta-analysis showed that flow diversion was preferable for unruptured intracranial aneurysms as its lower value of total cost per case (weighted mean difference, 5705.906; 95% confidence interval [CI], [4938.536, 6473236]; P < 0.001), fluoroscopy time per case (weighted mean difference, 25.786; 95% CI, 17.169-34.377; P < 0.001), and retreatment rates (odds ratio [OR], 7.127; 95% CI, [3.525, 14.410]; P < 0.001), at the same time, a higher rate of immediate completed occlusion (OR, 0.390; 95% CI, [0.224, 0.680]; P = 0.001) and follow-up completed occlusion (OR, 0.173; 95% CI, [0.080, 0.375]; P < 0.001) was demonstrated in the flow diversion group. There was no difference on intraoperative complication rates (P = 0.070), procedure-related mortality (P = 0.609) and rupture rates (P = 0.408), modified Rankin Scale (mRS) 0-2 at discharge (P = 0.077), and mRS 0-2 at follow-up (P = 0.484).ConclusionsThe use of flow diversion for the treatment of unruptured intracranial aneurysms may reduce total cost per case, fluoroscopy time per case, retreatment rates, and increases immediate completed occlusion and follow-up completed occlusion rates without affecting the results of mRS and intraoperative complication.Copyright © 2019 Elsevier Inc. All rights reserved.

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