Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA.
Department of Neurosurgery, University of Arizona, Tucson, Arizona, USA.
J Neurointerv Surg. 2019 Jul;11(7):683-689. doi: 10.1136/neurintsurg-2018-014517. Epub 2019 Jan 4.
Bifurcation aneurysms can be treated with stent-assisted coiling using two stents in a Y-configuration. We aim to investigate the angiographic and clinical outcomes of Y-stent constructs for the treatment of intracranial aneurysms.
A systematic review of PubMed, Ovid MEDLINE, and Ovid EMBASE databases was conducted based on PRISMA guidelines. The study selection was performed using the 'Ryyan' application. Our analysis included 18 studies with 327 patients. Inclusion criteria were: articles published from January 2000 to November 2017, English language, including cerebral aneurysms treated via Y-stenting, and ≥5 cases with radiographic/clinical outcomes. Technical notes, editorials, reviews, and animal studies were excluded. A random-effect meta-analysis was performed on angiographic and clinical outcomes, including aneurysm occlusion, modified Rankin Scale, neurological outcome, and procedure-related mortality. 95% CIs and event rates were estimated. Statistical heterogeneity was assessed using statistics.
The procedure-related good outcome rate was 92% and complete occlusion rate was 91%. The permanent neurological deficit rate was 4% and procedure-related mortality was 2%. The procedure-related stroke rate was 12%. A total of 28/146 (19%) patients had ruptured aneurysms. At long-term follow-up, overall stroke rate was 9% in patients with unruptured aneurysm. The mortality rate was higher in cases with ruptured aneurysms than in those with unruptured aneurysms (18% vs 0.8%; p<0.001).
Y-stenting for bifurcation aneurysms yields a high rate of complete occlusion and low rates of mortality and stroke. Careful patient selection is needed.
分叉部动脉瘤可以采用 Y 型支架辅助弹簧圈栓塞治疗，使用两个支架。我们旨在研究 Y 型支架构建物治疗颅内动脉瘤的血管造影和临床结果。
根据 PRISMA 指南，对 PubMed、Ovid MEDLINE 和 Ovid EMBASE 数据库进行系统评价。研究选择使用“Ryyan”应用程序进行。我们的分析包括 18 项研究，共 327 例患者。纳入标准为：2000 年 1 月至 2017 年 11 月发表的文章，使用英文，包括通过 Y 型支架治疗的脑动脉瘤，且有≥5 例患者的影像学/临床结果。排除技术说明、社论、综述和动物研究。对血管造影和临床结果（包括动脉瘤闭塞、改良 Rankin 量表、神经结局和与手术相关的死亡率）进行随机效应荟萃分析。估计 95%置信区间和事件发生率。使用 I² 统计量评估统计学异质性。
与手术相关的良好结局率为 92%，完全闭塞率为 91%。永久性神经功能缺损率为 4%，与手术相关的死亡率为 2%。与手术相关的卒中率为 12%。共有 28/146（19%）例患者的动脉瘤为破裂状态。在长期随访中，未破裂动脉瘤患者的总体卒中率为 9%。破裂动脉瘤患者的死亡率高于未破裂动脉瘤患者（18%比 0.8%；p<0.001）。
分叉部动脉瘤的 Y 型支架辅助弹簧圈栓塞治疗具有较高的完全闭塞率、较低的死亡率和卒中性。需要仔细选择患者。
