Antiplatelet therapy for standalone coiling of ruptured intracranial aneurysms: a systematic review and meta-analysis

Safety and efficacy of tirofiban in the endovascular treatment of intracranial aneurysms: a systematic evaluation and meta-analysis

Patients with intracranial aneurysms (IA) undergoing endovascular treatment face varying risks and benefits when tirofiban is used for thromboprophylaxis during surgery. Currently, there is a lack of high-level evidence summarizing this information. This study aims to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of tirofiban during endovascular treatment of IA. Relevant studies published before November 2024 were searched in the PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials databases. The primary outcomes were intracranial hemorrhage (ICH), thrombosis, and thrombolysis. Secondary outcomes included any non-ICH bleeding events (NoICH-BE), ischemic stroke (IS), intraoperative rupture aneurysm(IRA), follow-up prognosis, and Raymond and Roy classification (RROC). Meta-analysis was performed using Revman 5.3 and StataMP 64 to assess efficacy (thrombosis, IS, thrombolysis) and safety (ICH, NoICH-BE, IRA). A total of 33 studies involving 3,617 IA patients were included. The meta-analysis showed that after the use of tirofiban, the pooled risk (PR) for ICH was 2% ([95% CI, 1-3%]; P < 0.001), for NoICH-BE was 0% ([95% CI, 0-2%]; P > 0.05), for IRA was 2% ([95% CI, 1-3%]; P < 0.001), for thrombosis was 3% ([95% CI, 2-4%]; P < 0.001), for IS was 2% ([95% CI, 0-3%]; P < 0.001), for thrombolysis was 96% ([95% CI, 91-99%]; P < 0.001), for good prognosis (mRS 0-2) was 91% ([95% CI, 85-95%]; P < 0.001), and for RROC 1-2 was 93% ([95% CI, 90-96%]; P < 0.001). This systematic review and meta-analysis demonstrate that the use of tirofiban during endovascular treatment of IA is both feasible and safe.

Propensity score-adjusted analysis on early tirofiban administration to prevent thromboembolic complications during stand-alone coil embolization of ruptured aneurysms

The glycoprotein IIb/IIIa antagonist tirofiban has been shown to prevent thromboembolic events during endovascular procedures, but the benefits and risks of its prophylactic early intraprocedural administration for stand-alone coil embolization of acutely ruptured aneurysms are still unclear. We conducted a retrospective single-center analysis of patients treated for aneurysmal subarachnoid hemorrhage with stand-alone coil embolization. Two study cohorts were compared according to the primary prophylactic antithrombotic medication during the procedure: patients receiving only intravenous heparin (HEP) versus patients receiving tirofiban in addition to heparin prior to final aneurysm obliteration (HEP + TF). Outcome endpoints were the incidence of angiographically visible thrombus formation or distal embolization, and the incidence of periprocedural intracranial hemorrhage (ICH). Of 204 cases, 159 were prophylactically treated with HEP and 45 with HEP + TF. Intraprocedural thromboembolic events were less frequent with HEP + TF before and after propensity score matching (PSM) (2.5% vs. 19.7%, p = 0.017). The incidence of ICH and symptomatic ICH did not differ between HEP + TF and HEP before and after PSM (20.5% vs. 30.7%, p = 0.29; and 5.1% vs. 4%, p = 0.88). Early intraprocedural tirofiban administration may be effective in preventing thromboembolic complications during stand-alone coil embolization of acutely ruptured aneurysms without increasing the risk of ICH.

Variability patterns in dual antiplatelet therapy following endovascular repair of intracranial aneurysms: Insight into regimen heterogeneity and the need for a consensus

This comprehensive review delves into the evolving field of neurointervention for intracranial aneurysms, exploring the critical adjunct of Dual Antiplatelet Therapy (DAPT) to endovascular coiling, stent-assisted coiling (SAC), flow-diversion stents, and flow-disruption (intrasaccular) devices. Despite growing evidence supporting the success of DAPT in reducing thromboembolic events, the lack of consensus on optimal regimens, doses, and duration is evident. Factors contributing to this variability include genetic polymorphisms affecting treatment response and ongoing debates regarding the clinical significance of hemorrhagic complications associated with DAPT. This review analyzes pre- and post-procedural antiplatelet usage across various interventions. The imperative lies in ongoing research to define optimal DAPT durations, ensuring a nuanced approach to the delicate balance between thrombosis and hemorrhage in intracranial aneurysm management.

Network Meta-Analysis of C5 Palsy After Anterior Cervical Decompression of Three to Six Levels: Comparing Three Different Procedures

STUDY DESIGN

Systematic review and meta-analysis.

OBJECTIVE

Using a network meta-analysis (NMA), this study aimed to compare the risks of C5 palsy after three different procedures of anterior cervical decompression.

SUMMARY OF BACKGROUND DATA

C5 palsy is a well-known complication affecting the quality of life after anterior procedures. Due to the limited evidence on the various procedures available, we evaluate the basis for selection to prevent palsy and achieve maximal decompression in cases spanning 3-6 levels.

MATERIALS AND METHODS

We conducted a comprehensive search for C5 palsy and complications after 3representative procedures, including anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and their combination (hybrid), involving 3 to 6 intervertebral levels. The incidence of C5 palsy was compared using a NMA.

RESULTS

We identified 1655 patients in 11 studies who met inclusion criteria. Sixty-nine patients (4.2%) developed delayed C5 palsies. The incidences among ACDF, ACCF, and hybrid cases were 2.3% (16/684, 95% CI: 1.4% to 3.8%), 6.4% (39/613, 95% CI: 4.7% to 8.6%), and 3.9% (14/358, 95% CI: 2.3% to 6.5%), respectively ( P < 0.01). A NMA was performed for 15 pairwise comparisons across the 3 procedure arms: ACDF versus hybrid, 7/232 (3.0%) versus 11/234 (4.7%); hybrid versus ACCF, 14/301 (4.3%) versus 18/224 (8.0%); ACCF versus ACDF, 38/523 (7.8%) versus 16/619 (2.6%). Compared with ACDF, the risk of C5 palsy was significantly higher in ACCF (odds ratio: 2.72, 95% CI: 1.47 to 5.01), whereas ACDF versus hybrid did not significantly differ in risk (odds ratio: 1.56, 95% CI: 0.68 to 3.60).

CONCLUSION

We determined that ACCF was associated with a higher risk of postoperative C5 palsy than ACDF in cases spanning 3 to 6 intervertebral levels. If practicable, ACDF surgery may be an appropriate choice for cases requiring anterior decompression of 3 to 6 levels.

LEVEL OF EVIDENCE

Level III.

Mid-to-long term safety and efficacy of Woven EndoBridge device for Treatment of intracranial wide neck aneurysms: A systematic review and meta-analysis

BACKGROUND

In recent 10 years, Woven EndoBridge(WEB) device has been used as endovascular instrumentation for treating wide neck Bifurcation aneurysms. Its safety and efficacy in the mid-term (6-24 months) and long-term (more than 24 months) follow-up period have yet to be systematically reviewed.

PURPOSE

To evaluate the WEB device safety and efficacy, relevant literature and publications were extensively reviewed, and a meta-analysis was conducted.

DATA RESOURCE

All relevant literature/publications were achieved from Pubmed, Cochrane, Embase, and Web of Science databases.

RESULTS

767 patients that were studied in 13 literature were included. The focus of this review was placed on the clinical and anatomic outcomes. Complete occlusion was achieved in 67.3% (95% CI, 59.0-75.5%) and 69.3% (95% CI, 55.7-82.8%) of the cases at mid- and long-term follow-up. The rate of adequate occlusion was 86.6% (95% CI, 83.0-90.2%) and 90.1% (95% CI, 85.5-94.4%) for the mid and long-term, respectively. 51 patients (8.8%; 95% CI,5.6-11.9%) and 18 (8.1%; 95% CI,0.8-15.5%) received retreatments during mid- and long-term follow-up, respectively. 410 patients from 427 (94.3%; 95% CI, 89.7-98.9%) showed favorable clinical outcomes. The all-cause mortality rate was 3.5% (95% CI, 1.4-5.6%), where only a few cases were related to the WEB implantation. The WEB device deployment was associated with an overall clinical complication rate of 4.1% (95% CI, 2.7-6.6%), 3 hemorrhagic (1.2%; 95% CI, 0.2-2.6%), and 30 thromboembolic (4.0%; 95% CI, 4.0- 6.0%) complications.

CONCLUSIONS

The findings reveal the satisfactory safety and effectiveness of the WEB device for the Treatment of wide-neck aneurysms during mid-to-long-term follow-up, indicating the high potential of the WEB device for wide application.

Worldwide productivity and research trends of publications concerning stent application in acutely ruptured intracranial aneurysms: A bibliometric study

Background

Stenting is a common clinical practice to treat acutely ruptured intracranial aneurysm (RIA). Although multiple studies have demonstrated its long-term safety and effectiveness, there is currently a lack of bibliometric analysis on stent application in acutely RIA. This study sought to summarize the current status of research in this field and lay a foundation for further study.

Materials and methods

Related publications were searched in the Web of Science Core Collection (WoSCC) database. Data analysis and visualization were performed by R and CiteSpace software.

Results

A total of 275 publications published in English from 1997 to 2022 were included in this study. The growth of publications slowed down. The reference co-citation network identified 13 clusters with a significant network (Q = 0.7692) and convincing clustering (S = 0.9082). The research focus was acutely RIA and the application of stents during interventional procedures. The main trends of research were: (1) development of materials, and (2) safety of stent application in acutely RIA. The United States contributed the most articles, and Jianmin Liu was the most prolific author. Mayo Clinic was the leading institution in this field. Most articles were published in Interventional Neuroradiology.

Conclusions

This study analyzed the research trends, hotspots and frontiers of stent application in acutely RIA. It is our hope that the results obtained could provide useful information to researchers to get a clearer picture about their future research directions in this field.