Stent-assisted coiling and balloon-assisted coiling in the management of intracranial aneurysms: A systematic review & meta-analysis.

BACKGROUND: Stent-assisted coiling and balloon-assisted coiling are well-established minimally invasive techniques for treatment of intracranial aneurysms. The aim of this study was to use meta-analysis methods to compare clinical outcomes of aneurysms treated with stent-assisted coiling versus balloon-assisted coiling. METHODS: We searched for two-arm prospective studies and retrospective studies that compared the clinical outcomes in patients that received stent-assisted or balloon-assisted aneurysm treatment. Database search was performed through May 2015. Odds ratios (OR) with 95% confidence intervals (CI) were used to compare the clinical outcomes in patients that underwent either stent-assisted or balloon-assisted coiling for intracranial aneurysms management. RESULTS: Complete occlusion rates at the end of the coiling procedure were similar between patients that received stent-assisted and balloon-assisted aneurysm treatment (OR=0.763, 95% CI=0.47 to 1.23, P=0.270). However, complete occlusion rates were higher with stent-assisted coiling at 6months or later after the procedure (OR=1.82, 95% CI=1.21 to 2.74). The overall complication rates and retreatment rates in patients with recurrence were similar between stent-assisted and balloon-assisted aneurysm treatments. CONCLUSION: Stent-assisted coiling achieved better complete occlusion rates of aneurysms at 6months or later after the procedure compared to balloon-assisted coiling, without being associated with a higher risk of intraprocedural complications and retreatment.

Effect of subarachnoid hemorrhage on voltage-dependence calcium channel current in cerebral artery smooth muscle cells.

OBJECTIVE: To investigate the effect of subarachnoid hemorrhage (SAH) on voltage-dependent calcium channel (VDCC) current in cerebral artery smooth muscle cells (SMCs), oxyhemoglobins (OxyHb) concentration and vasospasm. METHOD: Thirty-six clean SD rats were used to establish SAH model by injecting autologous arterial blood into suprasellar cistern with the aid of stereotaxic instrument. They were divided into arterial SAH group (14 rats), venous SAH group (13 rats) and sham operation group (9 rats), and OxyHb concentrations were measured in the first two groups. Relative membrane surface area of cerebral artery SMCs, resting potential and VDCC current were measured using a patch clamp at day 3 after modeling; cerebral blood flow (CBF) was measured by using fluorescent microsphere-based lateral flow assay. RESULTS: OxyHb concentration of arterial SAH group (127±4 g/L) was higher than that of venous SAH group (54±6 g/L) and sham operation group (50±5 g/L), with significant difference (P<0.05); The maximum VDCC current (3.22±0.31 pA/pF) of the arterial SAH group was obviously higher than that of venous SAH group (2.19±0.27 pA/pF) and sham operation group (2.18±0.29 pA/pF), also showing a significant difference (P<0.05). For arterial SAH group, VDCC current consisted of L- and R-type calcium current, and for venous SAH group the VDCC current consisted of L-type calcium current; CBF of arterial SAH group (0.83±0.14 ml/g/min) was significantly higher than that of venous SAH group (1.28±0.28 ml/g/min) and sham operation group (1.35±0.19 ml/g/min) (P<0.05). CONCLUSION: The effect of arterial SAH was greater on the expression and function of VDCCs in cerebral artery SMCs than venous SAH. This may be explained by the differences in the concentration and composition of pathogenic agents for vasospasm in the arterial and venous blood, such as OxyHb.