Tau Noam, Sadeh-Gonik Udi, Aulagner Gilles, Turjman Francis, Gory Benjamin, Armoiry Xavier
Joint Department of Medical Imaging, University of Toronto, 610 University Avenue, Room 3-923, ON M5T 2M9, Toronto, Canada.
Radiology Department, Rabin Medical Center (Beilinson Campus), Petach Tikva, Israel.
Clin Neurol Neurosurg. 2018 Mar;166:110-115. doi: 10.1016/j.clineuro.2018.01.025. Epub 2018 Jan 31.
Endovascular treatment of wide-neck intracranial aneurysms (IAs) is challenging, especially in bifurcation location. The intra-saccular flow-disruptor Woven EndoBridge (WEB) offers a new concept of endovascular therapy for wide-neck IAs. We performed an update of a systematic review aimed to report the feasibility, effectiveness and safety of WEB device therapy.
A systematic review was conducted using several electronic databases (including PUBMED and EMBASE), searching for studies published between October 2015 and December 2017 (those published between January 2010 and September 2015 were included in our initial systematic review). Outcomes were: success of implantation, peri-procedural complications, mortality, and adequate occlusion (complete occlusion or neck remnant).
In total (initial review + update), 12 uncontrolled case-series studies were included, reporting outcomes for 940 patients (68.6% female; mean age, 57 years) harboring 962 IAs. Most IAs were wide-neck bifurcation aneurysms (75%-100%), mainly at middle cerebral artery (37%) and anterior communicating artery (24.6%). Feasibility was 97% (95% confidence interval [CI], 95%-99%), and 9% (95%CI, 5%-14%) of cases required additional treatment. There were 14% (95%CI, 9%-19%) peri-procedural complications. After a median clinical follow-up of 7 months, mortality was 5% (95%CI, 1%-10%) and was higher in series with larger proportions of ruptured IAs. At last angiographic follow-up (median, 7 months; range, 3-27.9 months), adequate occlusion rate was 81% (95%CI, 73%-88%).
Although WEB showed high rates of adequate aneurysm occlusion at mid-term, procedure-related complications and mortality rates were not negligible. Future studies should compare the WEB device with other treatment options.
颅内宽颈动脉瘤（IA）的血管内治疗具有挑战性，尤其是在分叉部位。囊内血流干扰装置编织型血管内桥接器（WEB）为颅内宽颈动脉瘤的血管内治疗提供了一种新的概念。我们对一项系统评价进行了更新，旨在报告WEB装置治疗的可行性、有效性和安全性。
使用多个电子数据库（包括PUBMED和EMBASE）进行系统评价，检索2015年10月至2017年12月发表的研究（2010年1月至2015年9月发表的研究纳入我们最初的系统评价）。观察指标包括：植入成功率、围手术期并发症、死亡率和充分栓塞（完全栓塞或瘤颈残留）。
总共（初始评价+更新）纳入12项非对照病例系列研究，报告了940例患者（女性占68.6%；平均年龄57岁）的962个颅内动脉瘤的治疗结果。大多数颅内动脉瘤为宽颈分叉动脉瘤（75%-100%），主要位于大脑中动脉（37%）和前交通动脉（24.6%）。可行性为97%（95%置信区间[CI]，95%-99%），9%（95%CI，5%-14%）的病例需要额外治疗。围手术期并发症发生率为14%（95%CI，9%-19%）。中位临床随访7个月后，死亡率为5%（95%CI，1%-10%），在破裂颅内动脉瘤比例较高的系列中死亡率更高。在最后的血管造影随访中（中位时间7个月；范围3-27.9个月），充分栓塞率为81%（95%CI，73%-88%）。
虽然WEB在中期显示出较高的动脉瘤充分栓塞率，但与手术相关的并发症和死亡率不容忽视。未来的研究应将WEB装置与其他治疗选择进行比较。
