From the Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.
From the Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
AJNR Am J Neuroradiol. 2022 Jul;43(7):1004-1011. doi: 10.3174/ajnr.A7539. Epub 2022 Jun 16.
Although the flow diverter has advantages in the treatment of intracranial aneurysms, pooled studies that directly compare it with conventional endovascular treatments are rare.
Our aim was to compare the safety and efficacy of flow-diverter and conventional endovascular treatments in intracranial aneurysms.
We performed a comprehensive search of the literature using PubMed, EMBASE, and the Cochrane Database.
We included only studies that directly compared the angiographic and clinical outcomes of flow-diverter and conventional endovascular treatments.
Random effects or fixed effects meta-analysis was used to pool the cumulative rate of short- and long-term angiographic and clinical outcomes.
Eighteen studies with 1001 patients with flow diverters and 1133 patients with conventional endovascular treatments were included; 1015 and 1201 aneurysm procedures were performed, respectively. The flow-diverter group had aneurysms of a larger size (standard mean difference, 0.22; 95% CI, 0.03-0.41; = .026). There was a higher risk of complications in the flow-diverter group compared with the conventional endovascular group (OR, 1.4; 95% CI, 1.01-1.96; = .045) during procedures. The follow-up angiographic results of flow-diverter treatment indicated a higher rate of complete occlusion (OR, 2.55; 95% CI, 1.70-3.83; < .001) and lower rates of recurrence (OR, 0.24; 95% CI, 0.12-0.46; < .001) and retreatment (OR, 0.31; 95% CI, 0.21-0.47; < .001).
Limitations include a retrospective, observational design in some studies, high heterogeneity, and selection bias.
Compared with the conventional endovascular treatments, the placement of a flow diverter may lead to more procedure-related complications, but there is no difference in safety, and it is more effective in the long term.
尽管血流导向装置在颅内动脉瘤治疗中具有优势，但直接比较其与传统血管内治疗的汇总研究很少。
本研究旨在比较血流导向装置和传统血管内治疗颅内动脉瘤的安全性和疗效。
我们使用 PubMed、EMBASE 和 Cochrane 数据库进行了全面的文献检索。
仅纳入直接比较血流导向装置和传统血管内治疗的血管造影和临床结局的研究。
使用随机效应或固定效应荟萃分析来汇总短期和长期血管造影和临床结局的累积发生率。
纳入了 18 项研究，共纳入 1001 例接受血流导向装置治疗的患者和 1133 例接受传统血管内治疗的患者；分别进行了 1015 例和 1201 例动脉瘤手术。血流导向装置组的动脉瘤体积较大（标准均数差值，0.22；95%CI，0.03-0.41； =.026）。与传统血管内治疗组相比，血流导向装置组术中并发症风险更高（比值比，1.4；95%CI，1.01-1.96； =.045）。血流导向装置治疗的随访血管造影结果显示完全闭塞率较高（比值比，2.55；95%CI，1.70-3.83；< .001），复发率较低（比值比，0.24；95%CI，0.12-0.46；< .001）和再治疗率较低（比值比，0.31；95%CI，0.21-0.47；< .001）。
部分研究存在回顾性、观察性设计、高度异质性和选择偏倚的局限性。
与传统血管内治疗相比，血流导向装置的放置可能会导致更多与操作相关的并发症，但在安全性方面没有差异，长期效果更好。
