Department of Neuroradiology, ASST Sette Laghi, University of Insubria, Varese, Italy.
Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Brescia, Italy.
J Stroke Cerebrovasc Dis. 2022 Mar;31(3):106284. doi: 10.1016/j.jstrokecerebrovasdis.2021.106284. Epub 2022 Jan 7.
Flow diversion is becoming an increasingly established practice for the treatment of acutely ruptured intracranial aneurysms. In this study the authors present a literature review and meta-analysis, adding a retrospective review of institutional registry on emergency treatment of aRIA with flow diverter stent.
A systematic search of PubMed, SCOPUS, Ovid MEDLINE, and Ovid EMBASE was performed on April 20, 2021, extrapolating 35 articles. R language 'meta' and 'metafor' packages were used for data pooling. The DerSimonian-Laird model was used to calculate the pooled effect. The I value and Q statistic evaluated study heterogeneity. Additionally, the authors retrospectively reviewed their institutional database for the treatment and outcomes of all patients with acutely ruptured intracranial aneurysms treated with flow diverter stent placement from May 2010 to November 2020 was performed.
From the systematic literature review and meta-analysis, the pooled proportion of complete aneurysm occlusion was 78%, with a pooled rate of 79%, 71%, 80%, and 50% for dissecting, saccular, fusiform, and mycotic aneurysms, respectively. The pooled proportion of aneurysm rebleeding and intrastent stenosis was 12% and 15% respectively, for a total of 27% rate. The analysis of authors retrospective register showed an overall mortality rate of 16.7% (3/18), with a low but not negligible postprocedural rebleeding and intrastent thrombosis rates (5.6% and 11.1% respectively).
Although increasingly utilized in the management of selected patients with acutely ruptured intracranial aneurysms, flow diversion for acutely ruptured intracranial aneurysms treatment presents rebleeding and intrastent stenosis rates not negligible.
血流导向装置在治疗急性破裂颅内动脉瘤中的应用越来越广泛。本研究作者进行了文献回顾和荟萃分析，并对机构注册处关于使用血流导向支架治疗急性破裂颅内动脉瘤的紧急治疗进行了回顾性回顾。
作者于 2021 年 4 月 20 日在 PubMed、SCOPUS、Ovid MEDLINE 和 Ovid EMBASE 上进行了系统搜索，共提取了 35 篇文章。使用 R 语言的“meta”和“metafor”包进行数据汇总。使用 DerSimonian-Laird 模型计算汇总效应。I ²值和 Q 统计量评估研究异质性。此外，作者还回顾性地审查了他们机构数据库中所有在 2010 年 5 月至 2020 年 11 月期间使用血流导向支架治疗的急性破裂颅内动脉瘤患者的治疗和结局。
从系统文献综述和荟萃分析来看，完全闭塞动脉瘤的汇总比例为 78%，分别为 79%、71%、80%和 50%的夹层、囊状、梭形和真菌性动脉瘤。动脉瘤再出血和支架内狭窄的汇总比例分别为 12%和 15%，总发生率为 27%。作者回顾性登记分析显示，总体死亡率为 16.7%（3/18），但术后再出血和支架内血栓形成的发生率较低但不容忽视（分别为 5.6%和 11.1%）。
尽管血流导向装置在治疗特定的急性破裂颅内动脉瘤患者中越来越多地应用，但对于急性破裂颅内动脉瘤的治疗，再出血和支架内狭窄的发生率不容忽视。
