Intracranial aneurysm is a severe cerebral disorder involving complicated risk factors and endovascular coiling is a common therapeutic selection for intracranial aneurysm. The recurrence is a clinical challenge in intracranial aneurysms after coil embolization. With this study, we provided a meta-analysis of the risk factors for the recurrence of intracranial aneurysm after coil embolization. Nine studies were included with a total of 1,270 studies that were retrieved from the database. The sample size of patients with intracranial aneurysms ranged from 241 to 3,530, and a total of 9,532 patients were included in the present meta-analysis. The intracranial aneurysms that occurred in middle cerebral artery (MCA) (OR = 1.09, 95% CI: 1.03–1.16, P = 0.0045) and posterior circulation (OR = 2.01, 95% CI: 1.55–2.60, P = 0.000) presented the significantly higher risk of recurrence after coil embolization. Meanwhile, intracranial aneurysms of size > 7 mm (OR = 5.38, 95%CI: 3.76–7.70, P = 0.000) had a significantly higher risk of recurrence after coil embolization. Moreover, ruptured aneurysm (OR = 2.86, 95% CI: 2.02–4.04, P = 0.000) and subarachnoid hemorrhage (SAH) (OR = 1.57, 95% CI: 1.20–2.06, P = 0.001) was positively correlated with the risk of recurrence after coil embolization. In conclusion, this meta-analysis identified the characteristics of intracranial aneurysms with MCA, posterior circulation, size > 7 mm, ruptured aneurysm, and SAH as the risk factors of recurrence after coil embolization for intracranial aneurysms.

Background. Intracranial aneurysm serves as a prevalent cerebral disorder leading to the low-quality life and financial burden of the patients. Flow diversion and coil embolization have been confirmed as common therapeutic strategies for intracranial aneurysms. In this work, we identified and compared the cost between the flow diversion and coil embolization in the treatment of intracranial aneurysms in a meta-analysis. Methods. We downloaded literatures that are published before Feb 2021 from Cochrane Library, Embase, and Pubmed using terms including “flow diversion”, “pipeline embolization device”, “coil embolization”, “coiling”, “Intracranial aneurysms”, and “Cerebral aneurysms”. The data were analyzed by STATA 15.1. Differences in treatment costs were determined by WMD (95% CI). Results. A total of 1332 articles were included in the search of the limited terms, and 8 were selected after eliminating duplicate and unwanted studies. Our data indicated that the total cost of flow diversion for intracranial aneurysms is significantly lower than coil embolization ( WMD = − 4419.12 , 95% CI: -6292.21 to -2546.03, p ≤ 0.001 ). In addition, we explored the retreatment hospitalization cost of flow diversion and coil embolization for intracranial aneurysms. We found that the retreatment hospitalization cost of flow diversion for intracranial aneurysms is significantly higher than coil embolization ( WMD = 3203.85 , 95% CI: 1904.60 to 4503.10, p ≤ 0.001 ). Conclusion. We concluded that the total cost was lower, and the retreatment hospitalization costs of flow diversion were higher than coil embolization for the treatment of intracranial aneurysms. Our finding provides valuable insights into the application of flow diversion and coil embolization in intracranial aneurysm therapy. Flow diversion may be applied as a major treatment with the consideration of retreatment.

Background. Aneurysmal subarachnoid hemorrhage (aSAH) is an acute cerebrovascular illness with a pronounced rate of disability and fatality. Assessing the risk of rupture in unruptured intracranial aneurysms (UIAs) can guide early clinical intervention to avoid subarachnoid hemorrhage (SAH). Current methods to assess the occurrence of aSAH at the molecular level are inadequate. Numerous studies have shown that immunity and inflammation are the initiating factors of UIAs rupture, which provides a potential theoretical support for constructing a risk model for aSAH occurrence based on immune-related genes. Methods. GSE36791 containing 61 samples was used as the training set, and GSE73378 containing 226 samples was used as the validation set, and the above data sets were obtained from the Gene Expression Omnibus database. All samples were gene expression profiling from peripheral blood cells. Using R software to identify differential genes and key gene modules and explore the underlying biological processes of differential genes. Immune-related analyses were based on ssGSEA and CIBERSORT algorithms. Using Cox regression to fit the risk model for aSAH occurrence with 3 randomly selected immune-related genes, and validating the model in the test set. Result. A total of 22 hub genes were obtained by weighted gene co-expression network analysis and gene differential expression analysis. Functional enrichment analysis showed that hub genes were mainly enriched in immune and inflammation-related pathways. The results showed that neutrophils and monocytes made up the largest proportion of the samples. CD6, SLP and SLC2A11 were randomly selected to construct risk model for aSAH occurrence. Our analysis resulted in an AUC value of 0.859 for the training set and 0.627 for the validation set, indicating that the model has some accuracy and potential clinical application. Conclusion. We identified 22 key genes associated with immunity and randomly selected 3 genes to construct and validate a risk model for the development of SAH due to aneurysm rupture. We determined the likelihood of intracranial aneurysm rupture based on the model score. It is possible to quickly and conveniently guide whether early intervention is needed for unruptured aneurysms at the molecular level to prevent the formation of SAH and related complications. In addition, pivotal gene-mediated inflammation provides a new perspective for future studies on the mechanisms of aSAH initiation and subsequent neurological deterioration.