Background and aim

The use of endoluminal flow diversion in bifurcation aneurysms has been questioned due to the potential for complications and lower occlusion rates. In this study we assessed outcomes of endovascular treatment of intracranial sidewall and bifurcation aneurysms with flow diverters

Methods

In July 2020, a literature search for all studies utilizing endoluminal flow diverter treatment for sidewall or bifurcation aneurysms was performed. Data were collected from studies that met our inclusion/exclusion criteria by two independent reviewers and confirmed by a third reviewer. Using random-effects meta-analysis the target outcomes including overall complications (hematoma, ischemic events, minor ischemic stroke, aneurysm rupture, side vessel occlusion, stenosis, thrombosis, transient ischemic stroke, and other complications), perioperative complications, and follow-up (long-term) aneurysm occlusion were intestigated.

Results

Overall, we included 35 studies with 1084 patients with 1208 aneurysms. Of these aneurysms, 654 (54.14%) and 554 (45.86%) were classified as sidewall and bifurcation aneurysm, respectively, based on aneurysm location. Sidewall aneurysms had a similar total complication rate (R) of 27.12% (95% CI, 16.56%–41.09%), compared with bifurcation aneurysms (R, 20.40%, 95% CI, 13.24%–30.08%) (p = 0.3527). Follow-up angiographic outcome showed comparable complete occlusion rates for sidewall aneurysms (R 69.49%; 95%CI, 62.41%–75.75%) and bifurcation aneurysms (R 73.99%; 95% CI, 65.05%–81.31%; p = 0.4328).

Conclusions

This meta-analysis of sidewall and bifurcation aneurysms treated with endoluminal flow diverters demonstrated no significant differences in complications or occlusion rates. These data provide new information that can be used as a benchmark for comparison with emerging devices for the treatment of bifurcation aneurysms.

中文翻译：

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腔内分流器治疗侧壁和分叉动脉瘤：并发症和血管造影结果的系统回顾和荟萃分析

背景和目标

由于潜在的并发症和较低的闭塞率，在分叉动脉瘤中使用腔内分流术一直受到质疑。在这项研究中，我们评估了使用分流器对颅内侧壁和分叉动脉瘤进行血管内治疗的结果

方法

2020 年 7 月，对所有利用腔内分流器治疗侧壁或分叉动脉瘤的研究进行了文献检索。数据由两名独立审查员从符合我们的纳入/排除标准的研究中收集，并由第三名审查员确认。使用随机效应荟萃分析目标结果，包括总体并发症（血肿、缺血性事件、轻微缺血性卒中、动脉瘤破裂、侧血管闭塞、狭窄、血栓形成、短暂性缺血性卒中和其他并发症）、围手术期并发症和随访（长期）动脉瘤闭塞进行了研究。

结果

总体而言，我们纳入了 35 项研究，涉及 1084 名患者和 1208 个动脉瘤。在这些动脉瘤中，654 个 (54.14%) 和 554 个 (45.86%) 根据动脉瘤位置分别被归类为侧壁和分叉动脉瘤。侧壁动脉瘤的总并发症发生率 (R) 相似，为 27.12% (95% CI, 16.56%–41.09%)，而分叉动脉瘤 (R, 20.40%, 95% CI, 13.24%–30.08%) (p = 0.3527 ). 后续血管造影结果显示侧壁动脉瘤（R 69.49%；95%CI，62.41%–75.75%）和分叉动脉瘤（R 73.99%；95%CI，65.05%–81.31%；p = 0.4328）的完全闭塞率相当.

结论

这项对用腔内分流器治疗的侧壁和分叉动脉瘤的荟萃分析表明，并发症或闭塞率没有显着差异。这些数据提供了新信息，可用作与用于治疗分叉动脉瘤的新兴设备进行比较的基准。