Endovascular Treatment of Intracranial Aneurysms With Flow Diverters A Meta-Analysis
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TLDR
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.Abstract:
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 P 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.read more
Citations
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International retrospective study of the pipeline embolization device: a multicenter aneurysm treatment study
David F. Kallmes,Ricardo A. Hanel,Demetrius K. Lopes,Edoardo Boccardi,Alain Bonafe,Saruhan Cekirge,David Fiorella,Pascal Jabbour,Elad I. Levy,Cameron G. McDougall,Adnan H. Siddiqui,István Szikora,Henry H. Woo,Felipe C. Albuquerque,Hormozd Bozorgchami,Shervin R. Dashti,J Delgado Almandoz,Michael Kelly,R. I. Turner,B. K. Woodward,Waleed Brinjikji,Giuseppe Lanzino,Pedro Lylyk +22 more
TL;DR: Aneurysm treatment with the Pipeline Embolization Device is associated with the lowest complication rates when used to treat small ICA aneurysms and Procedure-related morbidity and mortality are higher in the treatment of posterior circulation and giant aneurYSms.
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Long-Term Clinical and Angiographic Outcomes Following Pipeline Embolization Device Treatment of Complex Internal Carotid Artery Aneurysms: Five-Year Results of the Pipeline for Uncoilable or Failed Aneurysms Trial
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TL;DR: The 5-yr findings demonstrate that PED is a safe and effective treatment for large and giant wide-necked aneurysms of the intracranial ICA, with high rates of complete occlusion and low rates of delayed adverse events.
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Endovascular treatment of cerebral aneurysms using flow-diverter devices: A systematic review.
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TL;DR: Treatment with FDDs is a feasible and effective technique for unruptured aneurysms with complex anatomy where coiling and clipping are difficult or impossible and to avoid complications and reduce the risk of morbidity and mortality.
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Comparison of Flow Diversion and Coiling in Large Unruptured Intracranial Saccular Aneurysms
Nohra Chalouhi,Stavropoula Tjoumakaris,Robert M. Starke,L. Fernando Gonzalez,Ciro Randazzo,David Hasan,Jeffrey F. McMahon,Saurabh Singhal,Lea A Moukarzel,Aaron S. Dumont,Robert H. Rosenwasser,Pascal Jabbour +11 more
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References
More filters
Journal ArticleDOI
Measuring inconsistency in meta-analyses
TL;DR: A new quantity is developed, I 2, which the authors believe gives a better measure of the consistency between trials in a meta-analysis, which is susceptible to the number of trials included in the meta- analysis.
Journal ArticleDOI
Meta-Analysis in Clinical Trials*
TL;DR: This paper examines eight published reviews each reporting results from several related trials in order to evaluate the efficacy of a certain treatment for a specified medical condition and suggests a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.
Journal ArticleDOI
Interaction revisited: the difference between two estimates
Douglas G. Altman,J M Bland +1 more
TL;DR: Interference is considered in terms of heterogeneity of treatment effect in subgroups in a randomised trial, such as two age groups, and interaction more generally.
Journal ArticleDOI
Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience.
Pedro Lylyk,Carlos Miranda,Rosana Ceratto,Angel Ferrario,Esteban Scrivano,Hugh Ramirez Luna,Aaron L. Berez,Quang Tran,Peter Kim Nelson,David Fiorella +9 more
TL;DR: The Pipeline Embolization Device (PED) as mentioned in this paper is a microcatheter-delivered endovascular construct designed to achieve the curative reconstruction of the parent arteries giving rise to wide-necked and fusiform intracranial aneurysms.
Journal ArticleDOI
The Pipeline Embolization Device for the Intracranial Treatment of Aneurysms Trial
TL;DR: Intracranial aneurysm treatment with the PED is technically feasible and can be achieved with a safety profile analogous to that reported for stent-supported coil embolization, as presented in the first prospective multicenter trial of a flow-diverting construct for the treatment of intracranialAneurysms.
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