Diffusion-weighted imaging lesions after endovascular treatment of cerebral aneurysms: A network meta-analysis

Lijuan Mo; Jianhe Yue; Wanli Yu; Xi Liu; Changhong Tan; Wuxue Peng; Xueying Ding; Lifen Chen

doi:10.3389/fsurg.2022.964191

Diffusion-weighted imaging lesions after endovascular treatment of cerebral aneurysms: A network meta-analysis

Front Surg. 2023 Jan 16:9:964191. doi: 10.3389/fsurg.2022.964191. eCollection 2022.

Authors

Lijuan Mo¹, Jianhe Yue², Wanli Yu², Xi Liu¹, Changhong Tan¹, Wuxue Peng¹, Xueying Ding³, Lifen Chen¹

Affiliations

¹ Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
² Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
³ Department of Neurology, Shenzhen University General Hospital, Shenzhen, China.

Abstract

Background: Thromboembolism 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.

Methods: A 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.

Results: The 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.

Conclusion: FD 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.

Keywords: diffusion-weighted imaging; intracranial aneurysms; intravascular devices; thromboembolism; treatment.

Publication types

Review

Grants and funding

This work was funded by the National Natural Science Foundation of China and the Kuanren talent program of the Second Affiliated Hospital of Chongqing Medical University (grant nos. 81771391 and 82001367).