Document Detail


Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis.
MedLine Citation:
PMID:  23321438     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Flow diverters are important tools in the treatment of intracranial aneurysms. However, their impact on aneurysmal occlusion rates, morbidity, mortality, and complication rates is not fully examined.
METHODS: We conducted a systematic review of the literature searching multiple databases for reports on the treatment of intracranial aneurysms with flow-diverter devices. Random effects meta-analysis was used to pool outcomes of aneurysmal occlusion rates at 6 months, and procedure-related morbidity, mortality, and complications across studies.
RESULTS: A total of 29 studies were included in this analysis, including 1451 patients with 1654 aneurysms. Aneurysmal complete occlusion rate was 76% (95% confidence interval [CI], 70%-81%). Procedure-related morbidity and mortality were 5% (95% CI, 4%-7%) and 4% (95% CI, 3%-6%), respectively. The rate of postoperative subarachnoid hemorrhage was 3% (95% CI, 2%-4%). Intraparenchymal hemorrhage rate was 3% (95% CI, 2%-4%). Perforator infarction rate was 3% (95% CI, 1%-5%), with significantly lower odds of perforator infarction among patients with anterior circulation aneurysms compared with those with posterior circulation aneurysms (odds ratio, 0.01; 95% CI, 0.00-0.08; P<0.0001). Ischemic stroke rate was 6% (95% CI, 4%-9%), with significantly lower odds of perforator infarction among patients with anterior circulation aneurysms compared with those with posterior circulation aneurysms (odds ratio, 0.15; 95% CI, 0.08-0.27; P<0.0001).
CONCLUSIONS: This meta-analysis suggests that treatment of intracranial aneurysms with flow-diverter devices is feasible and effective with high complete occlusion rates. However, the risk of procedure-related morbidity and mortality is not negligible. Patients with posterior circulation aneurysms are at higher risk of ischemic stroke, particularly perforator infarction. These findings should be considered when considering the best therapeutic option for intracranial aneurysms.
Authors:
Waleed Brinjikji; Mohammad H Murad; Giuseppe Lanzino; Harry J Cloft; David F Kallmes
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2013-01-15
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  44     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-21     Completed Date:  2013-03-11     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  442-7     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Mayo Clinic, OL 1-115, 200 SW First St, Rochester, MN 55905, USA. brinjikji.waleed@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Cerebrovascular Circulation* / physiology
Endovascular Procedures / instrumentation*,  methods*
Humans
Intracranial Aneurysm / epidemiology*,  physiopathology,  surgery*
Risk Factors
Treatment Outcome
Comments/Corrections
Comment In:
Stroke. 2013 May;44(5):e54   [PMID:  23532015 ]
Stroke. 2013 May;44(5):e55

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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