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Hydrogel coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms: a meta-analysis of randomized controlled trials.

ABSTRACT: BACKGROUND:Recent studies have shown conflicting results regarding the effect of hydrogel coils for treating intracranial aneurysm compared to bare platinum coils. We implemented a meta-analysis to assess the value of hydrogel coils in intracranial aneurysm treatment. METHODS:The MEDLINE, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) which had evaluated hydrogel coils versus bare platinum coils for intracranial aneurysms. RESULTS:We pooled 1526 patients from 4 RCTs with the mean follow-up time of more than 16 months. Hydrogel coils had reductions on mid-term recurrence (RR 0.78, 95% CI 0.65 to 0.94, P?=?0.008) and residual aneurysm (RR 0.71, 95% CI 0.57 to 0.88, P?=?0.002), but didn't show any significant differences in other favorable outcomes such as functional recovery, mortality and so on. In the subgroup analysis, we found that second-generation hydrogel coils might exhibit potential impacts on increasing mid-term complete occlusion (RR 1.26, 95% CI 1.07 to 1.48, P?=?0.005) and decreasing residual aneurysm neck. (RR 0.54, 95% CI 0.34 to 0.86, P?=?0.010). CONCLUSIONS:Hydrogel coils showed no significant efficacy on functional recovery but exhibited a lower rate of recurrences and residual aneurysms in patients with intracranial aneurysms.

SUBMITTER: Xue T

PROVIDER: S-EPMC6172718 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Hydrogel coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms: a meta-analysis of randomized controlled trials.

Xue Tao T Chen Zhouqing Z Lin Weiwei W Xu Jiayi J Shen Xuming X Wang Zhong Z

BMC neurology 20181005 1

<h4>Background</h4>Recent studies have shown conflicting results regarding the effect of hydrogel coils for treating intracranial aneurysm compared to bare platinum coils. We implemented a meta-analysis to assess the value of hydrogel coils in intracranial aneurysm treatment.<h4>Methods</h4>The MEDLINE, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) which had evaluated hydrogel coils versus bare platinum coils for intracranial aneurysms.<h4>Results</ ...[more]

PMID: 30290784

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Project description:BACKGROUND:Clopidogrel is routinely used to decrease ischemic complications during neurointerventional procedures. However, the efficacy may be limited by antiplatelet resistance. PURPOSE:Our aim was to analyze the efficacy of prasugrel compared with clopidogrel in the cerebrovascular field. DATA SOURCES:A systematic search of 2 large databases was performed for studies published from 2000 to 2018. STUDY SELECTION:According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting treatment-related outcomes of patients undergoing neurointerventional procedures under prasugrel, and studies comparing prasugrel and clopidogrel. DATA ANALYSIS:Random-effects meta-analysis was used to pool the overall rate of complications, ischemic and hemorrhagic events, and influence of the dose of prasugrel. DATA SYNTHESIS:In the 7 included studies, 682 and 672 unruptured intracranial aneurysms were treated under prasugrel (cases) and clopidogrel (controls), respectively. Low-dose (20 mg/5 mg; loading and maintenance doses) prasugrel compared with the standard dose of clopidogrel (300 mg/75 mg) showed a significant reduction in the complication rate (OR = 0.36; 95% CI, 0.17-74, P = .006; I2 = 0%). Overall, the ischemic complication rate was significantly higher in the clopidogrel group (40/672 = 6%; 95% CI, 3%-13%; I2 = 83% versus 16/682 = 2%; 95% CI, 1%-5%; I2 = 73%; P = .03). Low and high loading doses of prasugrel were associated with 0.6% (5/535; 95% CI, 0.1%-1.6%; I2 = 0%) and 9.3% (13/147; 95% CI, 0.2%-18%; I2 = 60%) intraperiprocedural hemorrhages, respectively (P = .001), whereas low and high maintenance doses of prasugrel were associated with 0% (0/433) and 0.9% (2/249; 95% CI, 0.3%-2%; I2 = 0%) delayed hemorrhagic events, respectively (P = .001). LIMITATIONS:Retrospective series and heterogeneous endovascular treatments were limitations. CONCLUSIONS:In our study, low-dose prasugrel compared with clopidogrel premedication was associated with an effective reduction of the ischemic events with an acceptable rate of hemorrhagic complications.

Dataset Information

Hydrogel coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms: a meta-analysis of randomized controlled trials.

Publications

Hydrogel coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms: a meta-analysis of randomized controlled trials.

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