Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
World Neurosurg. 2019 Jul;127:e888-e895. doi: 10.1016/j.wneu.2019.03.291. Epub 2019 Apr 6.
The use of the Pipeline embolization device (PED) for posterior circulation aneurysms is controversial. The aim of this study was to explore the safety and efficacy of PED for these aneurysms in a meta-analysis. Meta-regression was used to identify predictors for incomplete aneurysm occlusion and procedure-related complications.
PubMed, Web of Science, and OVID databases were searched to identify all published references evaluating the treatment effect of PED for posterior circulation aneurysms. Only studies written in English that reported original data and included >10 cases were considered for inclusion. Patient demographics, aneurysm characteristics, angiographic outcomes, and clinical outcomes were extracted. A random-effects model was adopted to pool the obliteration rates and complication rates across selected studies. Finally, we conducted meta-regression analysis to identify predictors of angiographic outcomes.
12 studies including 358 patients with 365 aneurysms were included. The pooled complete aneurysm obliteration rate was 82% (95% confidence interval 73%-90%), and pooled procedure-related complication rate was 18% (95% confidence interval 14%-22%). Increasing age predicted incomplete obliteration of aneurysms after PED treatment in these patients (P = 0.01).
PED is an alternative to treat intracranial aneurysms of the posterior circulation, achieving high complete occlusion rates, but it is less effective in elderly patients. The risk of procedure-related complications is not negligible. Further larger, long-term follow-up studies are needed before definitive conclusions can be drawn.
使用 Pipeline 栓塞装置（PED）治疗后循环动脉瘤存在争议。本研究旨在通过荟萃分析探讨 PED 治疗这些动脉瘤的安全性和有效性。采用 Meta 回归分析确定不完全动脉瘤闭塞和与手术相关并发症的预测因素。
检索 PubMed、Web of Science 和 OVID 数据库，以确定所有评估 PED 治疗后循环动脉瘤治疗效果的已发表参考文献。仅纳入报告原始数据且纳入病例数＞10 例的英文文献。提取患者人口统计学资料、动脉瘤特征、血管造影结果和临床结果。采用随机效应模型汇总所选研究中的闭塞率和并发症率。最后，我们进行 Meta 回归分析，以确定血管造影结果的预测因素。
纳入 12 项研究，共 358 例患者 365 个动脉瘤。完全动脉瘤闭塞率的合并率为 82%（95%置信区间 73%-90%），与手术相关的并发症发生率的合并率为 18%（95%置信区间 14%-22%）。在这些患者中，年龄的增加预示着 PED 治疗后动脉瘤不完全闭塞（P=0.01）。
PED 是治疗后循环颅内动脉瘤的一种替代方法，可实现较高的完全闭塞率，但在老年患者中的效果较差。与手术相关的并发症风险不容忽视。在得出明确结论之前，需要进一步开展更大规模、长期随访的研究。
