Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Krakow, Poland; International Evidence-Based Anatomy Working Group (iEBA-WG), 12 Kopernika Street, 31-034 Krakow, Poland.
Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Krakow, Poland.
Clin Imaging. 2021 Feb;70:81-88. doi: 10.1016/j.clinimag.2020.10.025. Epub 2020 Oct 24.
The following study aimed to summarize the overall safety and efficacy of the pCONus device in the treatment of wide-necked bifurcation aneurysms.
Major electronic medical databases were thoroughly searched to identify relevant studies. Data regarding the type of included studies, type of aneurysm and its location, treatment results measured in Raymond-Roy Occlusion Class (RROC) and its complications, as well as patients' neurological outcome at the discharge were extracted from the eligible studies and included in the meta-analysis. The subgroup analyses dependent on the aneurysm rupture status were also conducted.
A total of 8 studies (198 patients with 200 aneurysms) were included in this meta-analysis. The most common localization of the treated aneurysms was the middle cerebral artery with its pooled prevalence estimate (PPE) of 44.5%. Immediately after the procedure, RROC I (complete obliteration of the aneurysm) was observed in 46.8%, RROC II in 32.9%, while RROC III (residual aneurysm) in 20.3% of the patients. In a short-term follow-up, PPE of RROC I was 55.0%, RROC II 29.0%, and RROC III 16.1%. The PPE of intraprocedural complications was 17.3%, the most frequent were thromboembolic events, which were observed in 12.1% of all procedures. Poor neurological outcome at the discharge was noted with PPE of 9.6%.
The effectiveness and safety of wide-necked bifurcation aneurysm treatment utilizing the pCONus device is moderate. There is still a need for a consensus regarding the effective antiplatelet regimen in furtherance of diminishing the rate of thromboembolic events.
本研究旨在总结 pCONus 装置治疗宽颈分叉部动脉瘤的整体安全性和疗效。
全面检索主要电子医学数据库，以确定相关研究。从合格研究中提取纳入研究的类型、动脉瘤类型及其位置、以 Raymond-Roy 闭塞等级（RROC）衡量的治疗结果及其并发症，以及患者出院时的神经功能结局等数据，并纳入荟萃分析。还进行了依赖于动脉瘤破裂状态的亚组分析。
本荟萃分析共纳入 8 项研究（198 例患者 200 个动脉瘤）。治疗动脉瘤最常见的部位是大脑中动脉，其合并患病率估计值（PPE）为 44.5%。术后即刻，RROC I（完全闭塞动脉瘤）占 46.8%，RROC II 占 32.9%，而 RROC III（残余动脉瘤）占 20.3%。在短期随访中，RROC I 的 PPE 为 55.0%，RROC II 为 29.0%，RROC III 为 16.1%。术中并发症的 PPE 为 17.3%，最常见的是血栓栓塞事件，在所有手术中观察到 12.1%。出院时神经功能结局不良的 PPE 为 9.6%。
使用 pCONus 装置治疗宽颈分叉部动脉瘤的有效性和安全性中等。仍需要就有效的抗血小板方案达成共识，以降低血栓栓塞事件的发生率。
