Dengler Julius, Maldaner Nicolai, Gläsker Sven, Endres Matthias, Wagner Martin, Malzahn Uwe, Heuschmann Peter U, Vajkoczy Peter
Department of Neurosurgery, Charitx00E9; - Universitaetsmedizin Berlin, Berlin, Germany.
Cerebrovasc Dis. 2016;41(3-4):187-98. doi: 10.1159/000443485. Epub 2016 Jan 15.
Designing treatment strategies for unruptured giant intracranial aneurysms (GIA) is difficult as evidence of large clinical trials is lacking. We examined the outcome following surgical or endovascular GIA treatment focusing on patient age, GIA location and unruptured GIA.
Medline and Embase were searched for studies reporting on GIA treatment outcome published after January 2000. We calculated the proportion of good outcome (PGO) for all included GIA and for unruptured GIA by meta-analysis using a random effects model.
We included 54 studies containing 64 study populations with 1,269 GIA at a median follow-up time (FU-T) of 26.4 months (95% CI 10.8-42.0). PGO was 80.9% (77.4-84.4) in the analysis of all GIA compared to 81.2% (75.3-86.1) in the separate analysis of unruptured GIA. For each year added to patient age, PGO decreased by 0.8%, both for all GIA and unruptured GIA. For all GIA, surgical treatment resulted in a PGO of 80.3% (95% CI 76.0-84.6) compared to 84.2% (78.5-89.8, p = 0.27) after endovascular treatment. In unruptured GIA, PGO was 79.7% (95% CI 71.5-87.8) after surgical treatment and 84.9% (79.1-90.7, p = 0.54) after endovascular treatment. PGO was lower in high quality studies and in studies presenting aggregate instead of individual patient data. In unruptured GIA, the OR for good treatment outcome was 5.2 (95% CI 2.0-13.0) at the internal carotid artery compared to 0.1 (0.1-0.3, p < 0.1) in the posterior circulation. Patient sex, FU-T and prevalence of ruptured GIA were not associated with PGO.
We found that the chances of good outcome after surgical or endovascular GIA treatment mainly depend on patient age and aneurysm location rather than on the type of treatment conducted. Our analysis may inform future research on GIA.
由于缺乏大型临床试验证据，为未破裂的巨大颅内动脉瘤（GIA）设计治疗策略颇具难度。我们研究了手术或血管内治疗GIA后的结果，重点关注患者年龄、GIA位置以及未破裂的GIA。
检索Medline和Embase数据库，查找2000年1月以后发表的关于GIA治疗结果的研究。我们采用随机效应模型，通过荟萃分析计算所有纳入的GIA以及未破裂GIA的良好结局比例（PGO）。
我们纳入了54项研究，包含64个研究群体，共1269个GIA，中位随访时间（FU-T）为26.4个月（95%CI 10.8 - 42.0）。所有GIA分析中的PGO为80.9%（77.4 - 84.4），未破裂GIA单独分析中的PGO为81.2%（75.3 - 86.1）。患者年龄每增加一岁，所有GIA和未破裂GIA的PGO均下降0.8%。对于所有GIA，手术治疗后的PGO为80.3%（95%CI 76.0 - 84.6），血管内治疗后的PGO为84.2%（78.5 - 89.8，p = 0.27）。在未破裂GIA中，手术治疗后的PGO为79.7%（95%CI 71.5 - 87.8），血管内治疗后的PGO为84.9%（79.1 - 90.7，p = 0.54）。高质量研究以及呈现汇总而非个体患者数据的研究中PGO较低。在未破裂GIA中，颈内动脉处良好治疗结局的比值比为5.2（95%CI 2.0 - 13.0），而后循环处为0.1（0.1 - 0.3，p < 0.1）。患者性别、FU-T以及破裂GIA的患病率与PGO无关。
我们发现手术或血管内治疗GIA后获得良好结局的机会主要取决于患者年龄和动脉瘤位置，而非所采用的治疗类型。我们的分析可为未来GIA的研究提供参考。
