Flow diverter treatment for saccular unruptured intracranial aneurysms: A systematic review focussing on study quality and initial outcomes.

IF 4.5 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-09-09 DOI:10.1177/23969873251370992

Fabian Wenz, Tamara Wiedemann, Gabriel Je Rinkel, Nima Etminan

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引用次数: 0

Abstract

Introduction: Flow-diverting (FD) stents are increasingly used to treat small, unruptured intracranial aneurysms (UIA), but high-quality, unbiased data on initial complications and clinical outcomes were limited in previous literature reviews. We updated the literature review to assess quality, potential bias, complications and short-term outcomes in studies on FD-stents for UIAs.

Patients and methods: We systematically searched PubMed, Embase and Cochrane Library until January 9, 2025 for studies on FD-stents for UIAs. We assessed methodological quality using the methodological index for non-randomised studies (poor: 0-9, moderate: 10-13, good: 14-16), and financial conflicts of interest. The primary outcome was neurological outcome according to a validated outcome scale at 1-3 months after treatment. Secondary outcomes were clinical worsening and complications.

Results: We included 13 studies with 743 patients and 806 UIAs, of which 88.4% (95% CI: 85.7%-91.2%) were <10 mm. All studies were uncontrolled. The methodological quality was poor in six and moderate in seven studies. Financial conflicts of interest were reported in six studies. At 1-3 months after treatment, the proportion of patients were for mRS ⩾1 13.3% (95% CI: 10.0%-16.6%), mRS ⩾2 5.3% (95% CI: 3.2%-7.5%), mRS ⩾3 2.4% (95% CI: 0.1%-3.9%) and neurological worsening 3.1% (95% CI: 1.5%-4.6%). Complications within 3 months occurred in 12.7% (95% CI: 10.3%-15.0%).

Discussion and conclusion: The literature on FD-stents is methodologically weak and potentially biased by financial interests but still shows relevant proportions of complications and post-treatment morbidity. Currently, there are no good data supporting the use of FD-stents for UIAs where standard treatment options are available. Randomised-controlled trials are needed to compare safety, efficacy and durability between FD-stents and coiling or clipping.

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囊状未破裂颅内动脉瘤的分流治疗：一项关注研究质量和初步结果的系统综述。

导语：血流分流（FD）支架越来越多地用于治疗小的、未破裂的颅内动脉瘤（UIA），但在之前的文献综述中，关于初始并发症和临床结果的高质量、公正的数据有限。我们更新了文献综述，以评估fd支架治疗uia研究的质量、潜在偏倚、并发症和短期结果。患者和方法：我们系统地检索了PubMed、Embase和Cochrane图书馆，直到2025年1月9日，检索了fd支架治疗uas的研究。我们使用非随机研究的方法学指数（差：0-9，中等：10-13，好：14-16）和财务利益冲突来评估方法学质量。根据治疗后1-3个月的有效结果量表，主要结果是神经系统结果。次要结局为临床恶化和并发症。结果：我们纳入了13项研究，743名患者和806名uia，其中88.4% （95% CI: 85.7%-91.2%）为fd支架。讨论和结论：fd支架的文献方法学薄弱，可能受到经济利益的影响，但仍然显示出并发症和治疗后发病率的相关比例。目前，在有标准治疗选择的uia中，没有好的数据支持fd支架的使用。需要随机对照试验来比较fd支架与盘绕或夹持支架的安全性、有效性和耐久性。

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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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.