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Endovascular Treatment of Ruptured Blister-Like Aneurysms: A Systematic Review and Meta-Analysis with Focus on Deconstructive versus Reconstructive and Flow-Diverter Treatments
- Source :
- AJNR Am J Neuroradiol
- Publication Year :
- 2015
- Publisher :
- American Society of Neuroradiology, 2015.
-
Abstract
- BACKGROUND AND PURPOSE: Various endovascular techniques have been applied to treat blister-like aneurysms. We performed a systematic review to evaluate endovascular treatment for ruptured blister-like aneurysms. MATERIALS AND METHODS: We performed a comprehensive literature search and subgroup analyses to compare deconstructive versus reconstructive techniques and flow diversion versus other reconstructive options. RESULTS: Thirty-one studies with 265 procedures for ruptured blister-like aneurysms were included. Endovascular treatment was associated with a 72.8% (95% CI, 64.2%–81.5%) mid- to long-term occlusion rate and a 19.3% (95% CI, 13.6%–25.1%) retreatment rate. Mid- to long-term neurologic outcome was good in 76.2% (95% CI, 68.9%–8.4%) of patients. Two hundred forty procedures (90.6%) were reconstructive techniques (coiling, stent-assisted coiling, overlapped stent placement, flow diversion) and 25 treatments (9.4%) were deconstructive. Deconstructive techniques had higher rates of initial complete occlusion than reconstructive techniques (77.3% versus 33.0%, P = .0003) but a higher risk for perioperative stroke (29.1% versus 5.0%, P = .04). There was no difference in good mid- to long-term neurologic outcome between groups, with 76.2% for the reconstructive group versus 79.9% for the deconstructive group (P = .30). Of 240 reconstructive procedures, 62 (25.8%) involved flow-diverter stents, with higher rates of mid- to long-term complete occlusion than other reconstructive techniques (90.8% versus 67.9%, P = .03) and a lower rate of retreatment (6.6% versus 30.7%, P < .0001). CONCLUSIONS: Endovascular treatment of ruptured blister-like aneurysms is associated with high rates of complete occlusion and good mid- to long-term neurologic outcomes in most patients. Deconstructive techniques are associated with higher occlusion rates but a higher risk of perioperative ischemic stroke. In the reconstructive group, flow diversion carries a higher level of complete occlusion and similar clinical outcomes.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
Aneurysm, Ruptured
Aneurysm
Occlusion
medicine
Humans
Radiology, Nuclear Medicine and imaging
Embolization
Endovascular treatment
Stroke
Retrospective Studies
Interventional
business.industry
Endovascular Procedures
Retrospective cohort study
Intracranial Aneurysm
Perioperative
medicine.disease
Embolization, Therapeutic
Surgery
Treatment Outcome
Meta-analysis
Retreatment
Female
Stents
Neurology (clinical)
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- AJNR Am J Neuroradiol
- Accession number :
- edsair.doi.dedup.....844c50f1db3d4aa9d67821d5d9276e45