Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA.
Interv Neuroradiol. 2024 Jun;30(3):350-360. doi: 10.1177/15910199221117921. Epub 2022 Aug 5.
BACKGROUND: Surface modification of flow diverters (FDs) has been explored as a solution for reducing thrombotic risk of these devices, without necessarily using dual antiplatelet therapy (DAPT). If effective, this could pose a promising alternative for treatment of ruptured aneurysms not amenable to other modalities. METHODS: We performed a comprehensive search of PubMed, MEDLINE, and Embase databases following Preferred Reporting Items for Systematic reviews and Meta-analyzes guidelines. We included articles reporting use of surface-modified FDs for treatment of ruptured aneurysms. Demographics, subarachnoid hemorrhage (SAH) severity, aneurysm characteristics, devices used, periprocedural complications, angiographic outcomes, and mortality were extracted for sample size-based weighted analysis. RESULTS: Six studies comprising 59 patients with 64 aneurysms were included. Mean patient age was 56.6 ± 6.3 years and 60.6% (95% confidence interval [CI], 46.7-72.9%) were women. The anterior circulation was the location in 60.4% (95%CI, 45.5-73.5%) of aneurysms; 41.8% of the aneurysms were saccular (95%CI, 29.3-55.4%), 16.7% were fusiform (95%CI, 8.3-30.8%), 29.9% were dissecting (95%CI, 12.8-55.4%), 24.4% were blood-blister (95%CI, 15.2-36.7%), and 5.7% were mycotic (95%CI, 2-15.1%). Poor SAH grade was reported in 46.9% (95%CI, 33.3-60.9%). Adjunctive coiling was used in 33.2% (95%CI, 12.4-63.6%). Periprocedural thromboembolic and hemorrhagic complications occurred in 20% (95%CI, 7.1-45.1%) and 8.8% (95%CI, 3.7-19.5%), respectively. Complete occlusion was achieved in 76.4% (95%CI, 58.1-88.3%); no retreatments during follow-up were reported. Overall mortality was 15.1% (95%CI, 7.7-27.6%). There were no differences between single antiplatelet therapy (SAPT) and DAPT regimens with respect to periprocedural thromboembolic complications ( = 0.09), hemorrhagic ( = 0.834) complications, and mortality ( = 0.312). CONCLUSION: Surface-modified FD treatment of ruptured aneurysms resulted in high rates of thromboembolic complications and acceptable rates of hemorrhagic complications. A considerable proportion of aneurysms were nonsaccular. Rates of complete occlusion were high and retreatment were low. Importantly, no statistically significant difference was found between SAPT and DAPT with respect to complications and mortality.
背景：为降低这类装置的血栓风险，已经对血流导向装置（FD）的表面改性进行了探索，而不一定需要使用双联抗血小板治疗（DAPT）。如果有效，这可能为治疗不适合其他治疗方式的破裂动脉瘤提供一种很有前景的替代方法。
方法：我们根据系统评价和荟萃分析的首选报告项目，对 PubMed、MEDLINE 和 Embase 数据库进行了全面检索。我们纳入了报告使用表面改性 FD 治疗破裂动脉瘤的文章。提取样本量加权分析的人口统计学、蛛网膜下腔出血（SAH）严重程度、动脉瘤特征、使用的装置、围手术期并发症、血管造影结果和死亡率。
结果：共有 6 项研究纳入了 59 例 64 个动脉瘤患者。患者平均年龄为 56.6±6.3 岁，60.6%（95%置信区间 [CI]，46.7-72.9%）为女性。前循环是 60.4%（95%CI，45.5-73.5%）动脉瘤的位置；41.8%的动脉瘤为囊状（95%CI，29.3-55.4%），16.7%为梭形（95%CI，8.3-30.8%），29.9%为夹层（95%CI，12.8-55.4%），24.4%为血泡样（95%CI，15.2-36.7%），5.7%为真菌性（95%CI，2-15.1%）。报道的 SAH 严重程度差为 46.9%（95%CI，33.3-60.9%）。辅助弹簧圈栓塞的使用占 33.2%（95%CI，12.4-63.6%）。围手术期血栓栓塞和出血性并发症分别发生在 20%（95%CI，7.1-45.1%）和 8.8%（95%CI，3.7-19.5%）。完全闭塞率为 76.4%（95%CI，58.1-88.3%）；在随访期间没有报道再次治疗。总的死亡率为 15.1%（95%CI，7.7-27.6%）。在围手术期血栓栓塞并发症（ = 0.09）、出血并发症（ = 0.834）和死亡率（ = 0.312）方面，单一抗血小板治疗（SAPT）和 DAPT 方案之间没有差异。
结论：表面改性 FD 治疗破裂动脉瘤导致血栓栓塞并发症发生率高，出血性并发症发生率可接受。相当一部分动脉瘤是非囊状的。完全闭塞率高，再次治疗率低。重要的是，在并发症和死亡率方面，SAPT 和 DAPT 之间没有发现统计学上的显著差异。
J Neurointerv Surg. 2022-4
Cochrane Database Syst Rev. 2005-10-19
Medicine (Baltimore). 2025-4-25
Front Neurol. 2024-3-28
Acta Neurochir (Wien). 2024-3-11
J Neurointerv Surg. 2022-4
J Neurointerv Surg. 2021-11
Zotero 插件