Amoukhteh Melika, Hassankhani Amir, Jannatdoust Payam, Valizadeh Parya, Ghozy Sherief, Bilgin Cem, Kallmes David F
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA.
Interv Neuroradiol. 2024 Jun 14:15910199241262070. doi: 10.1177/15910199241262070.
Intracranial dissecting aneurysms present a challenging subset linked to considerable morbidity and mortality, necessitating effective therapeutic strategies to prevent complications. Traditional treatments face technical limitations, while emerging endovascular modalities like stent-assisted coiling, multiple stenting, and flow-diverting devices (FDDs) offer promise in reducing periprocedural risks and enhancing patient outcomes. The aim of this study is to compare the safety and efficacy outcomes of endovascular treatment for intracranial dissecting aneurysms using FDDs versus stents (with or without coiling).
A systematic review and meta-analysis were conducted following established guidelines. The search included PubMed, Scopus, Web of Science, and Embase databases up to July 30, 2023. Eligible studies reporting outcomes of interest in both FDD and stent-treated groups were included, and the data was extracted and analyzed using STATA software.
Six studies were analyzed, involving 131 patients in the FDD group and 199 patients in the stent group. The pooled rates for favorable functional outcomes (86.8% vs. 86%), mortality (3.9% vs. 6%), adequate occlusion (79.7% vs. 86.3%), aneurysm recurrence (1.3% vs. 13.3%), in-stent stenosis/thrombosis (7% vs. 6.9%), ischemic events/infarctions (6.7% vs. 7.8%), retreatment (7% vs. 8.6%), and technical success (100% vs. 98.7%) were comparable in individuals treated with FDDs and stents (p > 0.05 in all cases). Additionally, complete occlusion rates were not significantly different between FDD (62.7%) and stent-treated patients (75.2%) (p = 0.06). However, after excluding one study in a leave-one-out analysis of the random effects meta-analysis, a significant difference in the pooled rates of this outcome was observed between the FDD (59.2%) and stent (75.2%) groups (p = 0.034).
FDDs present a promising approach for the treatment of intracranial dissecting aneurysms, yielding outcomes that are roughly comparable to stent-based methods. However, the absence of randomized trials and data limitations highlight the need for further research to enhance treatment strategies.
颅内夹层动脉瘤是一个具有挑战性的亚组，与相当高的发病率和死亡率相关，因此需要有效的治疗策略来预防并发症。传统治疗面临技术限制，而新兴的血管内治疗方式，如支架辅助弹簧圈栓塞、多重支架置入和血流导向装置（FDDs），在降低围手术期风险和改善患者预后方面显示出前景。本研究的目的是比较使用FDDs与支架（带或不带弹簧圈栓塞）治疗颅内夹层动脉瘤的血管内治疗的安全性和有效性结果。
按照既定指南进行系统评价和荟萃分析。检索截至2023年7月30日的PubMed、Scopus、科学网和Embase数据库。纳入报告FDD组和支架治疗组感兴趣结果的合格研究，并使用STATA软件提取和分析数据。
分析了6项研究，FDD组有131例患者，支架组有199例患者。FDDs治疗和支架治疗患者在良好功能结局（86.8%对86%）、死亡率（3.9%对6%）、充分闭塞（79.7%对86.3%）、动脉瘤复发（1.3%对13.3%）、支架内狭窄/血栓形成（7%对6.9%）、缺血事件/梗死（6.7%对7.8%）、再次治疗（7%对8.6%）和技术成功率（100%对98.7%）方面的合并率相当（所有情况下p>0.05）。此外，FDD治疗患者（62.7%）和支架治疗患者（75.2%）的完全闭塞率无显著差异（p = 0.06）。然而，在随机效应荟萃分析的留一法分析中排除一项研究后，FDD组（59.2%）和支架组（75.2%）在该结果的合并率上观察到显著差异（p = 0.034）。
FDDs是治疗颅内夹层动脉瘤的一种有前景的方法，其结果与基于支架的方法大致相当。然而，缺乏随机试验和数据限制凸显了进一步研究以改进治疗策略的必要性。
