Sönmez Ö, Brinjikji W, Murad M H, Lanzino G
From the Departments of Neurosurgery (Ö.S., G.L.).
Radiology (W.B.)
AJNR Am J Neuroradiol. 2015 Jul;36(7):1293-8. doi: 10.3174/ajnr.A4360. Epub 2015 May 7.
Various endovascular techniques have been applied to the treatment of vertebrobasilar dissecting aneurysms, including parent artery preservation with coiling, stent placement or flow diverter placement, and trapping and proximal occlusion. We performed a systematic review and meta-analysis to study clinical and angiographic outcomes of patients undergoing endovascular treatment of vertebrobasilar dissecting aneurysms.
We performed a comprehensive literature search for studies on the endovascular treatment of vertebrobasilar dissecting aneurysms. From each study we abstracted the following data: immediate occlusion, long-term occlusion, long-term good neurologic outcome, perioperative morbidity, perioperative mortality, rebleed (ruptured only), recurrence, and retreatment. We performed subgroup analyses of patients undergoing deconstructive-versus-reconstructive techniques. Meta-analysis was performed by using a random effects model.
Seventeen studies with 478 patients were included in this analysis. Sixteen studies had at least 6 months of clinical/angiographic follow-up. Endovascular treatment was associated with high rates of long-term occlusion (87.0%; 95% CI, 74.0%-94.0%) and low recurrence (7.0%; 95% CI, 5.0%-10.0%) and retreatment rates (3.0%; 95% CI, 2.0%-6.0%). Long-term good neurologic outcome was 84.0% (95% CI, 65.0%-94.0%). Deconstructive techniques were associated with higher rates of long-term complete occlusion compared with reconstructive techniques (88.0%; 95% CI, 35.0%-99.0% versus 81.0%; 95% CI, 64.0%-91.0%; P < .0001). Deconstructive and reconstructive techniques were both associated with high rates of good neurologic outcome (86.0%; 95% CI, 68.0%-95.0% versus 92.0%; 95% CI, 86.0%-95.0%; P = .10).
Endovascular treatment of vertebrobasilar dissecting aneurysms is associated with high rates of complete occlusion and good long-term neurologic outcomes. Deconstructive techniques are associated with higher occlusion rates. There was no statistical difference in neurologic outcomes between groups, possibly due to low power.
多种血管内技术已应用于椎基底动脉夹层动脉瘤的治疗，包括保留载瘤动脉的弹簧圈栓塞、支架置入或血流导向装置置入，以及动脉瘤夹闭和近端闭塞。我们进行了一项系统评价和荟萃分析，以研究接受椎基底动脉夹层动脉瘤血管内治疗患者的临床和血管造影结果。
我们对有关椎基底动脉夹层动脉瘤血管内治疗的研究进行了全面的文献检索。从每项研究中，我们提取了以下数据：即刻闭塞、长期闭塞、长期良好神经功能结局、围手术期发病率、围手术期死亡率、再出血（仅破裂动脉瘤）、复发和再次治疗。我们对接受解构性与重建性技术治疗的患者进行了亚组分析。采用随机效应模型进行荟萃分析。
本分析纳入了17项研究共478例患者。16项研究有至少6个月的临床/血管造影随访。血管内治疗与较高的长期闭塞率（87.0%；95%CI，74.0%-94.0%）、较低的复发率（7.0%；95%CI，5.0%-10.0%）和再次治疗率（3.0%；95%CI，2.0%-6.0%）相关。长期良好神经功能结局为84.0%（95%CI，65.0%-94.0%）。与重建性技术相比，解构性技术与更高的长期完全闭塞率相关（88.0%；95%CI，35.0%-99.0%对81.0%；95%CI，64.0%-91.0%；P <.0001）。解构性和重建性技术均与较高的良好神经功能结局率相关（86.0%；95%CI，68.0%-95.0%对92.0%；95%CI，86.0%-95.0%；P = 0.10）。
椎基底动脉夹层动脉瘤的血管内治疗与较高的完全闭塞率和良好的长期神经功能结局相关。解构性技术与更高的闭塞率相关。两组间神经功能结局无统计学差异，可能是由于检验效能低。
