Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany.
EKFZ for Digital Health, Dresden University of Technology, Dresden, Germany.
J Neurointerv Surg. 2023 Sep;15(9):892-897. doi: 10.1136/jnis-2022-019249. Epub 2022 Aug 2.
Data on the safety and efficacy of flow diverters (FD) for the treatment of unruptured internal carotid artery (ICA) aneurysms with compressive neuro-ophthalmological symptoms (NOS) are scarce and comprise mainly small case series.
We performed a search of three databases and included series with ≥10 patients, with unruptured aneurysms of the ICA and NOS, treated with FD. Random-effects analysis of treatment results and safety was performed.
A total of 22 studies reporting on 594 patients were included. Pooled proportions of NOS recovery, improvement, transient and permanent worsening were: 47.4% (95% CI 35.0% to 60.1%); 74.5% (95% CI 67.9% to 80.2%); 7.1% (95% CI 3.3% to 14.7%); and 4.9% (95% CI 3.2% to 7.4%), respectively. Rates of complete recovery and improvement in patients with isolated visual symptoms were 30.6% (95% CI 12.5% to 57.7%) and 56.6% (95% CI 42.3% to 69.9%). Isolated oculomotor symptoms recovered completely in 47.8% (95% CI 29.9% to 66.3%) and improved in 78% (95% CI 69.2% to 84.9%). Morbidity occurred in 5% (95% CI 2.8% to 9%) and mortality in 3.9% (95% CI 2% to 7.5%) of patients. An increased likelihood of symptom improvement was observed when treatment was performed early (<1 month) after symptom onset (OR=11.22, 95% CI 3.9% to 32.5%).
Flow diversion promotes recovery or improvement of compressive symptoms in a large proportion of patients but is associated with significant rates of morbidity and mortality. Transient and permanent NOS worsening is not uncommon. Early treatment is of utmost importance, as it increases the likelihood of symptom improvement more than 10-fold.
关于血流导向装置（FD）治疗伴有压迫性神经眼科症状（NOS）的未破裂颈内动脉（ICA）动脉瘤的安全性和疗效的数据很少，主要包括小的病例系列。
我们对三个数据库进行了检索，并纳入了≥10 例患者的系列研究，这些患者的 ICA 未破裂动脉瘤伴有 NOS，并接受 FD 治疗。对治疗结果和安全性进行了随机效应分析。
共纳入 22 项研究，报道了 594 例患者。NOS 恢复、改善、一过性和永久性恶化的汇总比例分别为：47.4%（95%可信区间 35.0%至 60.1%）；74.5%（95%可信区间 67.9%至 80.2%）；7.1%（95%可信区间 3.3%至 14.7%）；4.9%（95%可信区间 3.2%至 7.4%）。孤立视觉症状患者完全恢复和改善的比例分别为 30.6%（95%可信区间 12.5%至 57.7%）和 56.6%（95%可信区间 42.3%至 69.9%）。孤立动眼神经症状完全恢复和改善的比例分别为 47.8%（95%可信区间 29.9%至 66.3%）和 78%（95%可信区间 69.2%至 84.9%）。5%（95%可信区间 2.8%至 9%）的患者发生了并发症，3.9%（95%可信区间 2%至 7.5%）的患者发生了死亡。症状出现后早期（<1 个月）治疗与症状改善的可能性增加有关（OR=11.22，95%CI 3.9%至 32.5%）。
血流导向装置可促进大部分患者压迫症状的恢复或改善，但与较高的并发症和死亡率相关。暂时性和永久性的 NOS 恶化并不少见。早期治疗至关重要，因为它使症状改善的可能性增加了 10 倍以上。
