Safety and Efficacy of Flow Diverter Treatment for Blood Blister–Like Aneurysm: A Systematic Review and Meta-Analysis
Autor: | Deyuan Zhu, Jianmin Liu, Puyuan Zhao, Yazhou Yan, Qinghai Huang, Rui Zhao, Guoli Duan |
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Rok vydání: | 2018 |
Předmět: |
medicine.medical_specialty
Self Expandable Metallic Stents Subgroup analysis Aneurysm Ruptured 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aneurysm Internal medicine medicine Humans Retrospective Studies business.industry Mortality rate Endovascular Procedures Intracranial Aneurysm Odds ratio Perioperative medicine.disease Embolization Therapeutic Confidence interval Treatment Outcome Blood blister Meta-analysis Surgery Neurology (clinical) business 030217 neurology & neurosurgery |
Zdroj: | World Neurosurgery. 118:e79-e86 |
ISSN: | 1878-8750 |
Popis: | Objective To clarify the safety and efficacy of flow diverter (FD) treatment for blood blister-like aneurysm (BBA) through a systematic review and literature analyzing perioperative and long-term clinical and angiographic outcomes. Methods We performed a comprehensive review of the current literature for studies with >2 patients related to FD treatment of BBAs published. A random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurologic outcome. Results We included 15 noncomparative studies with a total of 165 target BBAs. Complete occlusion rates were 72% (95% confidence interval [CI], 0.59-0.85). Recurrence occurred in 13% (95% CI, 0.04-0.29) and rebleeding in 3% (95% CI, -0.02 to 0.07) of patients. Procedure-related morbidity and mortality were 26% (95% CI, 0.19-0.33) and 3% (95% CI, -0.01 to 0.07), respectively. The rate of long-term good outcomes was 83% (95% CI, 0.77-0.89). Subgroup analysis indicated that a single FD strategy for BBA seemed to have a higher rate of good outcomes compared with an overlapped FD strategy (89.9% vs. 61.9%; odds ratio, 1.42; 95% CI, 1.25-14.98, P = 0.02). Complete occlusion rate and procedure-related morbidity rate did not see any significant difference between these 2 strategies. Conclusions Our meta-analysis suggests that in selected cases, FD can be safe and effective. A single FD strategy may result in a higher rate of good outcomes compared with an overlapped FD strategy. Ultimately, treatment of BBA should be considered on a case-by-case basis to maximize patient benefits and limit the risk of perioperative complications. |
Databáze: | OpenAIRE |
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