Background

The safety and efficacy of FD among distal AC aneurysms must be proved.

Purpose

To analyze the outcomes after FD among MCA, AcomA, and DACA aneurysms.

Data sources

A systematic search of three databases was performed for studies published from 2005 to 2018.

Study selection

According to PRISMA guidelines, we included studies reporting FD of distal AC aneurysms.

Data analysis

Random-effects meta-analysis was used to pool aneurysm occlusion and complication rates. From the individual patient data, univariate and multivariate analysis were used to test predictors of occlusion and complications.

Data synthesis

We included 27 studies (484 aneurysms). Long-term adequate occlusion rate (OKM C-D) was 82.7 % (295/364, 95 % CI = 77.4 %–87.9 %, I² = 52 %). Treatment-related complications were 12.5 % (63/410, 95 % CI = 9 %–16 %%, I² = 18.8 %), with 5.4 % (29/418, 95 % CI = 3.2–7.5 %, I² = 0 %) of morbidity. MCA location was an independent factor associated with lower occlusion (OR = 0.5, P = 0.03) and higher complication rates (OR = 1.8, P = 0.02), compared to AcomA and DACA aneurysms. PED (vs other stents) gave better occlusion rates (OR = 2.6, P = 0.002), whereas large/giant aneurysms were associated with higher odds of complications (OR = 2.2, P = 0.03). The rates of occlusion and narrowing of arteries covered by flow-diverter stents were 6.3 % (29/283, 95 % CI = 3.5 %–9.1 %, I² = 4.2 %) and 23.8 % (69/283, 95 % CI = 15.7 %–32 %, I² = 80 %), respectively. Symptoms related to occlusion and narrowing of the jailed arteries were 3.5 % (6/269, 95 % CI = 1.1 %–5 %, I² = 0 %) and 3 % (6/245, 95 % CI = 1 %–4 %, I² = 0 %), respectively.

Limitations

Small and retrospective series.

Conclusions

FD among distal AC aneurysms is effective, leading to adequate aneurysm occlusion in 83 % of cases. However, this strategy presents some limitations among MCA, and for larger lesions especially related to the higher rate of complications. Compared to the other devices, PED seems to be associated with a higher occlusion rate.

中文翻译：

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分流支架治疗远端远端前循环动脉瘤的荟萃分析

背景

必须证明FD在远端AC动脉瘤中的安全性和有效性。

目的

分析MCA，AcomA和DACA动脉瘤FD后的结局。

数据源

对2005年至2018年发表的研究进行了三个数据库的系统搜索。

研究选择

根据PRISMA指南，我们纳入了报告远端AC动脉瘤FD的研究。

数据分析

随机效应荟萃分析用于合并动脉瘤的闭塞和并发症发生率。从患者的个人数据来看，单因素和多因素分析用于检验阻塞和并发症的预测指标。

数据综合

我们纳入了27项研究（484个动脉瘤）。长期足够的阻塞率（OKM CD）为82.7％（295 / 364，95％CI = 77.4％–87.9％，I ²  = 52％）。与治疗相关的并发症为12.5％（63/410，95％CI = 9％–16 %%，I ²  = 18.8％），其中5.4％（29/418，95％CI = 3.2–7.5％，I ²  = 0％）的发病率。 与AcomA和DACA动脉瘤相比，MCA位置是与较低的闭塞（OR = 0.5，P  = 0.03）和较高的并发症发生率（OR = 1.8，P = 0.02）相关的独立因素。PED（与其他支架相比）闭塞率更高（OR = 2.6，P  = 0.002），而大/大动脉瘤的并发症几率更高（OR = 2.2，P = 0.03）。分流支架覆盖的动脉闭塞和狭窄率分别为6.3％（29/283，95％CI = 3.5％–9.1％，I ²  = 4.2％）和23.8％（69/283，95％CI = 15.7％–32％，I ²  = 80％）。与入狱和狭窄有关的症状分别为3.5％（6/269，95％CI = 1.1％–5％，I ²  = 0％）和3％（6/245，95％CI = 1％–4） ％，I ²  = 0％）。

局限性

小型回顾性系列。

结论

远端AC动脉瘤之间的FD有效，导致83％的患者充分闭塞动脉瘤。但是，这种策略在MCA中存在一些局限性，对于较大的病变尤其是与较高的并发症发生率有关。与其他设备相比，PED似乎具有更高的阻塞率。