Ocílio Ribeiro Gonçalves, Anderson Matheus Pereira da SIlva, Mariana Lee Han, Filipe Virgilio Ribeiro, Mariana Oliveira, Rafael Reis de Oliveira, Milene Vitória Sampaio Sobral, Ahmet Gunkan, Marcio Yuri Ferreira, Jhon E Bocanegra-Becerra, Christian Ferreira, David Gordon, Yafell Serulle, David Langer
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引用次数: 0
Abstract
Introduction: Intracranial vertebral artery dissecting aneurysms (IVADAs) represent a rare but challenging condition associated with high morbidity and mortality. In the therapeutic landscape, endovascular interventions such as Flow Diversion (FD) and Stent-Assisted Coiling (SAC) are widely used for the management of IVADAs. The aim of this systematic review and meta-analysis is to compare the clinical outcomes and complications associated with FD and SAC techniques in the endovascular management of IVADAs.
Methods: We systematically searched PubMed, Embase, Web of Science and Scopus from inception to December 2024. This meta-analysis included retrospective cohort studies comparing flow diverters versus stent-assisted coiling in patients with IVADAs. The primary outcomes included in-stent stenosis, complete occlusion rates, and modified Rankin Scale (mRS) scores. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies. Statistical analyses were conducted using R software (version 4.4.0), with risk ratios (RR) and 95% confidence intervals (CI) calculated using the Mantel-Haenszel method. Heterogeneity was assessed using Cochran's Q test and I2 statistics, with an I2 > 40% considered significant. A leave-one-out analysis was performed to evaluate the influence of individual studies on the pooled estimates.
Results: A total of seven non-randomized studies were included in the meta-analysis comprising 649 patients with IVADAs. Long-term complete occlusion rates were similar between FD and SAC (RR 0.99; 95% CI 0.89-1.10; I2 = 0%). Favorable functional outcomes were marginally higher with FD (RR 1.04; 95% CI 1.00-1.10; I2 = 0%). Recurrence (RR 0.36; 95% CI 0.13-1.01; I2 = 0%) and retreatment rates (RR 0.44; 95% CI 0.16-1.17; I2 = 0%) were not significantly different between groups. In terms of safety outcomes, in-stent stenosis rates (RR 1.17; 95% CI 0.47-2.91; I2 = 0%) and complication rates (RR 0.74; 95% CI 0.40-1.35; I2 = 0%) were not statistically significantly different. Risk of bias assessment indicated an overall moderate risk across studies, with no study classified as having a serious risk of bias.
Conclusion: In this meta-analysis, FD and SAC demonstrated comparable efficacy and safety profiles in the treatment of IVADAs, with no significant differences in long-term complete occlusion, recurrence, retreatment, in-stent stenosis, or complication rates. In this context, FD is a promising technique to treat IVADAs.
期刊介绍：
Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.
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