Systematic Review and Meta-Analysis of Endovascular Therapy Effectiveness for Unruptured Saccular Intracranial Aneurysms.

IF 2.1 Q3 CLINICAL NEUROLOGY
Stroke (Hoboken, N.J.) Pub Date : 2024-03-01 Epub Date: 2024-01-25 DOI:10.1161/SVIN.123.001118
Sergio A Pineda-Castillo, Evan R Jones, Keely A Laurence, Lauren R Thoendel, Tanner L Cabaniss, Yan D Zhao, Bradley N Bohnstedt, Chung-Hao Lee
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引用次数: 0

Abstract

Background: Currently, endovascular treatment of intracranial aneurysms (ICAs) is limited by low complete occlusion rates. The advent of novel endovascular technology has expanded the applicability of endovascular therapy; however, the superiority of novel embolic devices over the traditional Guglielmi detachable coils (GDCs) is still debated. We performed a systematic review of literature that reported Raymond-Roy occlusion classification (RROC) rates of modern endovascular devices to determine their immediate and follow-up occlusion effectiveness for the treatment of unruptured saccular ICAs.

Methods: A search was conducted using electronic databases (PUBMED, Cochrane, ClinicalTrials.gov, Web of Science). We retrieved studies published between 2000-2022 reporting immediate and follow-up RROC rates of subjects treated with different endovascular ICA therapies. We extracted demographic information of the treated patients and their reported angiographic RROC rates.

Results: A total of 80 studies from 15 countries were included for data extraction. RROC rates determined from angiogram were obtained for 21,331 patients (72.5% females, pooled mean age: 58.2 (95% CI: 56.8-59.6), harboring 22,791 aneurysms. The most frequent aneurysm locations were the internal carotid artery (46.4%, 95% CI: 41.9%-50.9%), the anterior communicating artery (26.4%, 95% CI: 22.5%-30.8%), the middle cerebral artery (24.5%, 95% CI:19.2%-30.8%) and the basilar tip (14.4%, 95% CI:11.3%-18.3%). The complete occlusion probability (RROC-I) was analyzed for GDCs, the Woven EndoBridge (WEB), and flow diverters. The RROC-I rate was the highest in balloon-assisted coiling (73.9%, 95% CI: 65.0%-81.2%) and the lowest in the WEB (27.8%, 95% CI:13.2%-49.2%). The follow-up RROC-I probability was homogenous in all analyzed devices.

Conclusions: We observed that the coil-based endovascular therapy provides acceptable rates of complete occlusion, and these rates are improved in balloon-assisted coils. Out of the analyzed devices, the WEB exhibited the shortest time to achieve >90% probability of follow-up complete occlusion (~18 months). Overall, the GDCs remain the gold standard for endovascular treatment of unruptured saccular aneurysms.

未破裂骶骨颅内动脉瘤血管内治疗效果的系统性回顾和 Meta 分析。
背景:目前,颅内动脉瘤(ICA)的血管内治疗因完全闭塞率低而受到限制。新型血管内治疗技术的出现扩大了血管内治疗的适用范围;然而,新型栓塞装置是否优于传统的古列尔米可拆卸线圈(GDCs)仍存在争议。我们对报告了现代血管内设备雷蒙德-罗伊闭塞分类(RROC)率的文献进行了系统性回顾,以确定它们在治疗未破裂的囊状室内动脉时的即时和后续闭塞效果:使用电子数据库(PUBMED、Cochrane、ClinicalTrials.gov、Web of Science)进行检索。我们检索了 2000-2022 年间发表的研究,这些研究报告了接受不同血管内 ICA 治疗的受试者的即时和随访 RROC 率。我们提取了接受治疗患者的人口统计学信息及其报告的血管造影 RROC 率:共有来自 15 个国家的 80 项研究被纳入数据提取范围。根据血管造影确定了 21,331 名患者(72.5% 为女性,平均年龄为 58.2 岁(95% CI:56.8-59.6 岁),共 22,791 个动脉瘤的 RROC 率。最常见的动脉瘤位置是颈内动脉(46.4%,95% CI:41.9%-50.9%)、前交通动脉(26.4%,95% CI:22.5%-30.8%)、大脑中动脉(24.5%,95% CI:19.2%-30.8%)和基底动脉端(14.4%,95% CI:11.3%-18.3%)。对 GDC、编织内桥(WEB)和血流分流器的完全闭塞概率(RROC-I)进行了分析。球囊辅助卷曲术的 RROC-I 率最高(73.9%,95% CI:65.0%-81.2%),WEB 最低(27.8%,95% CI:13.2%-49.2%)。所有分析设备的随访RROC-I概率相同:我们观察到,基于线圈的血管内治疗可提供可接受的完全闭塞率,而球囊辅助线圈的完全闭塞率更高。在分析的设备中,WEB 实现随访完全闭塞概率大于 90% 的时间最短(约 18 个月)。总体而言,GDC 仍是血管内治疗未破裂囊状动脉瘤的黄金标准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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