神经介入手术中可拆卸与不可拆卸尖端微导管的疗效、安全性和 DMSO 兼容性比较：系统回顾与元分析》。

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology Pub Date : 2024-11-24 DOI:10.1016/j.neurad.2024.101234

Atakan Orscelik , Basel Musmar , Esref Alperen Bayraktar , Jonathan Cortese , Yigit Can Senol , Sherief Ghozy , Muhammed Amir Essibayi , Gokce Belge Bilgin , Madona Pakkam , Cem Bilgin , Waleed Brinjikji , David F. Kallmes

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引用次数: 0

摘要

背景：栓塞剂的发展要求使用与二甲基亚砜（DMSO）兼容的微导管，而可拆卸尖端微导管（DTMs）是一项重大创新，旨在降低栓塞手术中导管被卡住的风险。本研究旨在比较 DTM 与非可拆卸尖端微导管（Non-DTM）在神经血管疾病栓塞治疗中的有效性、安全性和 DMSO 兼容性：按照 PRISMA 指南，在 PubMed、Scopus、Embase 和 Web of Science 数据库中进行了系统性文献检索，直至 2024 年 2 月 25 日。主要结果包括技术成功率和微导管相关并发症，采用随机效应模型进行荟萃分析，计算比例和几率比（OR）及95%置信区间（Cl）：对涉及 2,185 名患者和 3,758 根导管（995 根 DTM 和 2763 根非 DTM）的 45 项研究进行了分析。我们的分析表明，与非 DTM 相比，DTM 的技术成功率（98.3% 对 97.6%，P=0.68）、良好预后（93.9% 对 93.6%，P=0.89）和微导管相关并发症的发生率相当。具体而言，DTM 的微导管夹持率和出血并发症发生率为 0.0%。41.7%（95%CI = 27.02-57.98）的病例实现了预定脱离，而过早脱离的情况很少见（0.1%；95%CI = 0.00-1.23）。在对比研究分析中，DTM 组和非 DTM 组之间的微导管相关并发症没有延迟：我们的研究证明了 DTM 在栓塞治疗中的安全性和有效性，强调了其与基于 DMSO 的栓塞剂的兼容性，以及在神经介入手术中改善患者预后的潜力。未来的研究应侧重于设计良好、规模更大、具有前瞻性的多中心比较研究，以加强证据基础，进一步优化 DTM 在血管内介入中的应用。

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Comparative efficacy, safety, and DMSO compatibility of detachable vs. non-detachable tip microcatheters in neurointerventional procedures: A systematic review and meta-analysis

Background

The evolution of embolic agents necessitates the use of microcatheters compatible with dimethyl sulfoxide (DMSO), with detachable tip microcatheters (DTMs) emerging as a significant innovation aimed at reducing the risk of catheter entrapment in embolization procedures. This study aims to compare the efficacy, safety, and DMSO compatibility of DTMs with non-detachable tip microcatheters (Non-DTMs) in the context of embolization treatments for neurovascular diseases.

Method

Following PRISMA guidelines, a systematic literature search was conducted across PubMed, Scopus, Embase, and Web of Science databases until February 25, 2024. Primary outcomes included technical success and microcatheter-related complications, with a meta-analysis performed using a random-effects model to calculate proportions and odds ratios (OR) with 95 % confidence intervals (Cl).

Results

Forty-five studies involving 2185 patients and 3758 catheters (995 DTMs and 2763 Non-DTMs) were analyzed. Our analysis revealed that DTMs were associated with comparable rates of technical success (98.3 % vs. 97.6 %, p = 0.68), favorable outcomes (93.9 % vs. 93.6 %, p = 0.89), and microcatheter-related complications compared to Non-DTMs. Specifically, DTMs showed a 0.0 % rate of microcatheter entrapment and hemorrhagic complications. Intended detachment was achieved in 41.7 % (95 % CI = 27.02–57.98) of cases and premature detachment was rare (0.1 %; 95 % %CI = 0.00–1.23). In the analysis of comparative studies, microcatheter-related complications did not defer between DTM and Non-DTM groups.

Conclusion

Our study demonstrates the safety and efficacy of DTMs in embolization treatments, emphasizing their compatibility with DMSO-based embolic agents and their potential to enhance patient outcomes in neurointerventional procedures. Future research should focus on well-designed, larger, prospective, comparative multi-center studies to strengthen the evidence base and further optimize the use of DTMs in endovascular interventions.

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来源期刊

Journal of Neuroradiology 医学-核医学

CiteScore

6.10

自引率

5.70%

发文量

142

审稿时长

6-12 weeks

期刊介绍： The Journal of Neuroradiology is a peer-reviewed journal, publishing worldwide clinical and basic research in the field of diagnostic and Interventional neuroradiology, translational and molecular neuroimaging, and artificial intelligence in neuroradiology. The Journal of Neuroradiology considers for publication articles, reviews, technical notes and letters to the editors (correspondence section), provided that the methodology and scientific content are of high quality, and that the results will have substantial clinical impact and/or physiological importance.