From the Neuroradiology Department (F.C., D.M., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
From the Neuroradiology Department (F.C., D.M., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
AJNR Am J Neuroradiol. 2018 May;39(5):852-858. doi: 10.3174/ajnr.A5591. Epub 2018 Mar 15.
The safety and efficacy of reconstructive and deconstructive endovascular treatments of very large/giant intracranial aneurysms are not completely clear.
Our aim was to compare treatment-related outcomes between these 2 techniques.
A systematic search of 3 data bases was performed for studies published from 1990 to 2017.
We selected series of reconstructive and deconstructive treatments with >10 patients.
Random-effects meta-analysis was used to analyze occlusion rates, complications, and neurologic outcomes.
Thirty-nine studies evaluating 894 very large/giant aneurysms were included. Long-term occlusion of unruptured aneurysms was 71% and 93% after reconstructive and deconstructive treatments, respectively ( = .003). Among unruptured aneurysms, complications were lower after parent artery occlusion (16% versus 30%, = .05), whereas among ruptured lesions, complications were lower after reconstructive techniques (34% versus 38%). Parent artery occlusion in the posterior circulation had higher complications compared with in the anterior circulation (36% versus 15%, = .001). Overall, coiling yielded lower complication and occlusion rates compared with flow diverters and stent-assisted coiling. Complication rates of flow diversion were lower in the anterior circulation (17% versus 41%, < .01). Among unruptured lesions, early aneurysm rupture (within 30 days) was slightly higher after reconstructive treatment (5% versus 0%, = .08) and after flow diversion alone compared with flow diversion plus coiling (7% versus 0%).
Limitations were selection and publication biases.
Parent artery occlusion allowed high rates of occlusion with an acceptable rate of complications for unruptured, anterior circulation aneurysms. Coiling should be preferred for posterior circulation and ruptured lesions, whereas flow diversion is relatively safe and effective for unruptured anterior circulation aneurysms.
对于非常大/巨大颅内动脉瘤的重建和解构血管内治疗的安全性和有效性尚不完全清楚。
我们旨在比较这两种技术的治疗相关结果。
对 1990 年至 2017 年发表的研究进行了系统的 3 个数据库搜索。
我们选择了 >10 例重建和解构治疗的系列研究。
使用随机效应荟萃分析分析闭塞率、并发症和神经学结果。
纳入了 39 项评估 894 例非常大/巨大动脉瘤的研究。未破裂动脉瘤的长期闭塞率分别为重建治疗后的 71%和解构治疗后的 93%（ =.003）。在未破裂的动脉瘤中，血管主干闭塞的并发症较低（16%比 30%， =.05），而在破裂病变中，重建技术的并发症较低（34%比 38%）。后循环中的血管主干闭塞比前循环中的并发症更高（36%比 15%， =.001）。总的来说，与血流导向装置和支架辅助线圈相比，线圈的并发症和闭塞率较低。在前循环中，血流分流的并发症发生率较低（17%比 41%， <.01）。在未破裂的病变中，与重建治疗（5%比 0%， =.08）和单独的血流分流（7%比 0%）相比，早期动脉瘤破裂（30 天内）在重建治疗后略高。
存在选择和发表偏倚。
血管主干闭塞可使未破裂、前循环动脉瘤达到较高的闭塞率，并发症发生率可接受。对于后循环和破裂病变，线圈应优先选择，而血流分流对于未破裂的前循环动脉瘤是相对安全有效的。
