Lv Xianli, Ge Huijian, He Hongwei, Jiang Chuhan, Li Youxiang
Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Neurol India. 2017 Jan-Feb;65(1):35-38. doi: 10.4103/0028-3886.198200.
The experience with respect to the treatment of giant intracranial aneurysms with flow-diversion devices is limited. The aim of the present systematic review was to evaluate the effect of the pipeline embolization device (PED) on giant intracranial aneurysms. Eligible related articles were identified by searching the PubMed, Web of Science, Springer, ScienceDirect, and OVID databases using "giant aneurysm" and "pipeline" as the search items. The date of the last search was November 20, 2015. This systematic review adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In a total of 9 eligible studies with 200 patients and 215 aneurysms, 40 (18.6%) giant (aneurysm diameter >25mm) intracranial aneurysms treated with PED were analyzed. During a 6 to 34 month follow-up, complete occlusion was achieved in 23 (57.5%) cases. Seven patients (17.5%) developed intracranial hemorrhage, 5 developed ischemic attack (12.5%), and 13 (32.5%) developed a mass effect after PED treatment. The complication rate was 77.8% in PED for giant vertebrobasilar artery aneurysms. The cumulative mortality rate for giant paraclinoid carotid artery and middle cerebral artery aneurysms was 13.3% and increased up to 50% for giant vertebrobasilar artery aneurysms. The complete obliteration rate of PED for giant intracranial aneurysms was approximately 60%. Mass effect is the most mechanism of complications. Complication and mortality rates associated with PED for giant vertebrobasilar artery aneurysms are still extremely high.
使用血流导向装置治疗巨大颅内动脉瘤的经验有限。本系统评价的目的是评估管道栓塞装置（PED）治疗巨大颅内动脉瘤的效果。通过以“巨大动脉瘤”和“管道”作为检索词，检索PubMed、科学网、施普林格、科学Direct和OVID数据库，确定符合条件的相关文章。最后一次检索日期为2015年11月20日。本系统评价采用系统评价和Meta分析的首选报告项目指南。在总共9项符合条件的研究中，涉及200例患者和215个动脉瘤，分析了40个（18.6%）接受PED治疗的巨大（动脉瘤直径>25mm）颅内动脉瘤。在6至34个月的随访期间，23例（57.5%）实现了完全闭塞。7例患者（17.5%）发生颅内出血，5例发生缺血性发作（12.5%），13例（32.5%）在PED治疗后出现占位效应。巨大椎基底动脉动脉瘤使用PED的并发症发生率为77.8%。巨大床突旁颈动脉和大脑中动脉动脉瘤的累积死亡率为13.3%，巨大椎基底动脉动脉瘤的累积死亡率高达50%。PED治疗巨大颅内动脉瘤的完全闭塞率约为60%。占位效应是最主要的并发症机制。巨大椎基底动脉动脉瘤使用PED的并发症和死亡率仍然极高。
