RT Journal Article
SR Electronic
T1 Acutely Ruptured Intracranial Aneurysms Treated with Flow-Diverter Stents: A Systematic Review and Meta-Analysis
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1669
OP 1675
DO 10.3174/ajnr.A5730
VO 39
IS 9
A1 F. Cagnazzo
A1 D.T. di Carlo
A1 M. Cappucci
A1 P.-H. Lefevre
A1 V. Costalat
A1 P. Perrini
YR 2018
UL http://www.ajnr.org/content/39/9/1669.abstract
AB BACKGROUND: The implantation of flow-diverter stents for the treatment of ruptured intracranial aneurysms required further investigation.PURPOSE: Our aim was to analyze the outcomes after flow diversion of ruptured intracranial aneurysms.DATA SOURCES: A systematic search of 3 databases was performed for studies published from 2006 to 2018.STUDY SELECTION: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies (from 2010 to 2018) reporting acutely ruptured intracranial aneurysms treated with flow diversion.DATA ANALYSIS: Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, rebleeding, and factors influencing the studied outcomes.DATA SYNTHESIS: We included 20 studies evaluating 223 patients with acutely ruptured intracranial aneurysms treated with flow-diverter stents. Immediate angiographic occlusion was obtained in 32% (29/86; 95% CI, 15.4%–48%; I2 = 79.6%) of aneurysms, whereas long-term complete/near-complete aneurysm occlusion was 88.9% (162/189; 95% CI, 84%–93.5%; I2 = 20.9%) (mean radiologic follow-up of 9.6 months). The treatment-related complication rate was 17.8% (42/223; 95% CI, 11%–24%; I2 = 52.6%). Complications were higher in the posterior circulation (16/72 = 27%; 95% CI, 14%–40%; I2 = 66% versus 18/149 = 11.7%; 95% CI, 7%–16%; I2 = 0%) (P = .004) and after treatment with multiple stents (14/52 = 26%; 95% CI, 14%–45%; I2 = 59%) compared with a single stent (20/141 = 10%; 95% CI, 5%–15%; I2 = 0%) (P = .004). Aneurysm rebleeding after treatment was 4% (5/223; 95% CI, 1.8%–7%; I2 = 0%) and was higher in the first 72 hours.LIMITATIONS: Small and retrospective series.CONCLUSIONS: Flow-diversion treatment of ruptured intracranial aneurysms yields a high rate of long-term angiographic occlusion with a relatively low rate of aneurysm rebleeding. However, treatment is associated with a complication rate of 18%. When coiling or microsurgical clipping are not feasible strategies, anterior circulation ruptured aneurysms can be effectively treated with a flow-diversion technique, minimizing the number of stents deployed. Given the 27% rate of complications, flow diversion for ruptured posterior circulation aneurysms should be considered only in selected cases not amenable to other treatments.ASAacetylsalicylic acidCPclopidogrelIQRinterquartile rangePRISMAPreferred Reporting Items for Systematic Reviews and Meta-Analyses