Treatment of Unruptured Distal Anterior Circulation Aneurysms with Flow-Diverter Stents: A Meta-Analysis
| Autor: | Riccardo Morganti, Federico Cagnazzo, Pierre-Henri Lefevre, Imad Derraz, Cyril Dargazanli, D. di Carlo, Gregory Gascou, Vincent Costalat, Paolo Perrini, Carlos Riquelme, Alain Bonafe |
|---|---|
| Přispěvatelé: | Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Azienda Ospedaliera Universitaria Pisana, University of Pisa - Università di Pisa, Salvy-Córdoba, Nathalie |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male [SDV.OT]Life Sciences [q-bio]/Other [q-bio.OT] medicine.medical_specialty [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery medicine.medical_treatment [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aneurysm Blood vessel prosthesis medicine.artery Occlusion medicine Anterior cerebral artery Humans Radiology Nuclear Medicine and imaging [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] Embolization Aged Retrospective Studies Interventional [SDV.OT] Life Sciences [q-bio]/Other [q-bio.OT] business.industry Endovascular Procedures Intracranial Aneurysm Retrospective cohort study MESH: Blood Vessel Prosthesis Endovascular Procedures/instrumentation Intracranial Aneurysm/surgery Stents Middle Aged medicine.disease Embolization Therapeutic Blood Vessel Prosthesis Surgery Anterior communicating artery Treatment Outcome [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] Female Neurology (clinical) business Complication 030217 neurology & neurosurgery |
| Zdroj: | American Journal of Neuroradiology American Journal of Neuroradiology, American Society of Neuroradiology, 2019 |
| ISSN: | 1936-959X 0195-6108 |
| Popis: | International audience; Background: The safety and efficacy of flow diversion among distal anterior circulation aneurysms must be proved.Purpose: Our aim was to analyze the outcomes after flow diversion among MCA, anterior communicating artery, and distal anterior cerebral artery aneurysms.Data sources: A systematic search of 3 databases was performed for studies published from 2005 to 2018.Study selection: According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting flow diversion of distal anterior circulation aneurysms.Data analysis: Random-effects meta-analysis was used to pool aneurysm occlusion and complication rates. From the individual patient data, univariate and multivariate analyses were used to test predictors of occlusion and complications.Data synthesis: We included 27 studies (484 aneurysms). The long-term adequate occlusion rate (O'Kelly-Marotta scale, C-D) was 82.7% (295/364; 95% CI, 77.4%-87.9%; I2 = 52%). Treatment-related complications were 12.5% (63/410; 95% CI, 9%-16%%; I2 = 18.8%), with 5.4% (29/418; 95% CI, 3.2%-7.5%; I2 = 0%) morbidity. MCA location was an independent factor associated with lower occlusion (OR = 0.5, P = .03) and higher complication rates (OR = 1.8, P = .02), compared with anterior communicating artery and distal anterior cerebral artery aneurysms. The Pipeline Embolization Device (versus other stents) gave better occlusion rates (OR = 2.6, P = .002), whereas large/giant aneurysms were associated with higher odds of complications (OR = 2.2, P = .03). The rates of occlusion and narrowing of arteries covered by flow-diverter stents were 6.3% (29/283; 95% CI, 3.5%-9.1%; I2 = 4.2%) and 23.8% (69/283; 95% CI, 15.7%-32%; I2 = 80%), respectively. Symptoms related to occlusion and narrowing of the jailed arteries were 3.5% (6/269; 95% CI, 1.1%-5%; I2 = 0%) and 3% (6/245; 95% CI, 1%-4%; I2 = 0%), respectively.Limitations: We reviewed small and retrospective series.Conclusions: Flow diversion among distal anterior circulation aneurysms is effective, leading to adequate aneurysm occlusion in 83% of cases. However, this strategy has some limitations among MCA and larger lesions, especially related to the higher rate of complications. Compared with the other devices, the Pipeline Embolization Device seems to be associated with a higher occlusion rate |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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