Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis
Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis
复制标题
使用分流装置治疗脑动脉瘤相关的并发症：系统评价和荟萃分析
DOI：
10.3171/2017.3.focus16450
复制
发表时间：
2017-06-01
影响因子：
4.1
通讯作者：
Li, Ming-Hua
中科院分区：
文献类型：
--
作者：
Zhou, Geng;Su, Ming;Li, Ming-Hua
本研究的目的是通过对已发表的研究进行荟萃分析，回顾有关使用血流分流装置（FDD）治疗颅内动脉瘤（IAs）的文献，并探讨FDD治疗IAs的安全性和并发症。方法使用施普林格、EBSCO、PubMed、Medline和Cochrane数据库对2016年1月前发表的所有可获取的论文进行系统的电子数据库检索，不限制发表年份。分析摘要、全文稿件和检索文献的参考文献列表。随机效应荟萃分析用于汇总各研究的并发症发生率。结果纳入60项研究，回顾性收集了3125例患者的资料。fdd的使用与总并发症发生率17.0%（95%可信区间[CI] 13.6%-20.5%）和低死亡率2.8%（95%可信区间[CI] 1.2%-4.4%）相关。神经系统发病率为4.5% （95% CI 3.2% ~ 5.8%）。两种常用的栓塞装置（Pipeline栓塞装置和Silk分流器）在并发症和死亡率方面无显著差异。IA破裂的总并发症发生率明显高于IA未破裂的发生率（优势比2.3,95% CI 1.2-4.3）。结论使用fdd治疗IAs在并发症和死亡率方面取得了令人满意的效果。在决定使用fdd治疗时应考虑并发症的风险。需要进一步研究不良事件发生的机制。
OBJECTIVE The objective of this study was to review the literature on the use of flow-diverting devices (FDDs) to treat intracranial aneurysms (IAs) and to investigate the safety and complications related to FDD treatment for IAs by performing a meta-analysis of published studies.METHODS A systematic electronic database search was conducted using the Springer, EBSCO, PubMed, Medline, and Cochrane databases on all accessible articles published up to January 2016, with no restriction on the publication year. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Random-effects meta-analysis was used to pool the complication rates across studies.RESULTS Sixty studies were included, which involved retrospectively collected data on 3125 patients. The use of FDDs was associated with an overall complication rate of 17.0% (95% confidence interval [CI] 13.6%-20.5%) and a low mortality rate of 2.8% (95% CI 1.2%-4.4%). The neurological morbidity rate was 4.5% (95% CI 3.2%-5.8%). No significant difference in the complication or mortality rate was observed between 2 commonly used devices (the Pipeline embolization device and the Silk flow-diverter device). A significantly higher overall complication rate was found in the case of ruptured IAs than in unruptured IA (odds ratio 2.3, 95% CI 1.2-4.3).CONCLUSIONS The use of FDDs in the treatment of IAs yielded satisfactory results with regard to complications and the mortality rate. The risk of complications should be considered when deciding on treatment with FDDs. Further studies on the mechanism underlying the occurrence of adverse events are required.