Zhou Geng, Su Ming, Yin Yan-Ling, Li Ming-Hua
Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai.
Shandong Academy of Chinese Medicine, Lixia, Jinan; and.
Neurosurg Focus. 2017 Jun;42(6):E17. doi: 10.3171/2017.3.FOCUS16450.
OBJECTIVE The objective of this study was to review the literature on the use of flow-diverting devices (FDDs) to treat intracranial aneurysms (IAs) and to investigate the safety and complications related to FDD treatment for IAs by performing a meta-analysis of published studies. METHODS A systematic electronic database search was conducted using the Springer, EBSCO, PubMed, Medline, and Cochrane databases on all accessible articles published up to January 2016, with no restriction on the publication year. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Random-effects meta-analysis was used to pool the complication rates across studies. RESULTS Sixty studies were included, which involved retrospectively collected data on 3125 patients. The use of FDDs was associated with an overall complication rate of 17.0% (95% confidence interval [CI] 13.6%-20.5%) and a low mortality rate of 2.8% (95% CI 1.2%-4.4%). The neurological morbidity rate was 4.5% (95% CI 3.2%-5.8%). No significant difference in the complication or mortality rate was observed between 2 commonly used devices (the Pipeline embolization device and the Silk flow-diverter device). A significantly higher overall complication rate was found in the case of ruptured IAs than in unruptured IA (odds ratio 2.3, 95% CI 1.2-4.3). CONCLUSIONS The use of FDDs in the treatment of IAs yielded satisfactory results with regard to complications and the mortality rate. The risk of complications should be considered when deciding on treatment with FDDs. Further studies on the mechanism underlying the occurrence of adverse events are required.
目的 本研究的目的是回顾关于使用血流导向装置（FDD）治疗颅内动脉瘤（IA）的文献，并通过对已发表研究进行荟萃分析，探讨FDD治疗IA的安全性和并发症。方法 使用施普林格、EBSCO、PubMed、Medline和Cochrane数据库，对截至2016年1月发表的所有可获取文章进行系统的电子数据库检索，对发表年份无限制。分析摘要、全文手稿以及检索文章的参考文献列表。采用随机效应荟萃分析汇总各研究的并发症发生率。结果 纳入60项研究，涉及回顾性收集的3125例患者的数据。使用FDD的总体并发症发生率为17.0%（95%置信区间[CI] 13.6%-20.5%），死亡率较低，为2.8%（95% CI 1.2%-4.4%）。神经功能障碍发生率为4.5%（95% CI 3.2%-5.8%）。在两种常用装置（Pipeline栓塞装置和Silk血流导向装置）之间，并发症或死亡率未观察到显著差异。破裂IA的总体并发症发生率显著高于未破裂IA（优势比2.3，95% CI 1.2-4.3）。结论 使用FDD治疗IA在并发症和死亡率方面取得了满意的结果。决定使用FDD治疗时应考虑并发症风险。需要进一步研究不良事件发生的潜在机制。
