Abstract
Flow diverter devices (FDDs) are increasingly used in the treatment of intracranial aneurysm. The safety and feasibility of FDD were assessed in published literature. In accordance with strict inclusion criteria, Medline, Embase, Cochrane, China National Knowledge Infrastructure, and Web of Science databases were searched for literature that covers a period until February 2015. The baseline characteristics of patients, aneurysms, aneurysm occlusion, morbidity, and mortality were also collected. A meta-analysis was conducted using STATA 12.0, and a chi-squared test was performed to evaluate whether statistically significant differences existed between complications and mortality of aneurysm patients. Finally, a total of 48 studies were selected, including 2508 patients with 2826 aneurysm cases. The mean follow-up interval is 6.3 months, and the aneurysm occlusion rate is 77.9 % (95 % CI 73.8–81.9, I 2 = 43.4 %). The total morbidity and mortality rates are 9.8 and 3.8 %, respectively. The rates of spontaneous rupture and intraparenchymal hemorrhage are 2.0 and 2.5 %, respectively. The rate of ischemic stroke is 5.5 %. The morbidity and mortality rates of giant aneurysms are significantly higher than those of small and large aneurysms (χ 2 = 56.96, p < 0.05; χ 2 = 14.88, p < 0.05). The morbidity rates of posterior aneurysms are significantly higher than those of anterior (χ 2 = 11.29, p < 0.05) and unruptured aneurysms (χ 2 = 10.36, p < 0.05), respectively. The publication bias of aneurysm occlusion was detected by Begg’s rank, and the corrected result is less than 0.05. Our meta-analysis suggests that the treatment of intracranial aneurysm with FDD is feasible and effective with a high occlusion rate, acceptable morbidity, and mortality. However, the morbidity or mortality of giant aneurysms is still high.
Similar content being viewed by others
References
Alderazi YJ, Shastri D, Kass-Hout T, Prestigiacomo CJ, Gandhi CD (2014) Flow diverters for intracranial aneurysms. Stroke Res Treat 2014:415653
Almandoz JED, Crandall BM, Scholz JM, Fease JL, Anderson RE, Kadkhodayan Y, Tubman DE (2013) Pre-procedure P2Y12 reaction units value predicts perioperative thromboembolic and hemorrhagic complications in patients with cerebral aneurysms treated with the pipeline embolization device. J Neurointerv Surg 5:Iii3–Iii10
Arrese I, Sarabia R, Pintado R, Delgado-Rodriguez M (2013) Flow-diverter devices for intracranial aneurysms: systematic review and meta-analysis. Neurosurgery 73:193–199
Briganti F, Napoli M, Tortora F, Solari D, Bergui M, Boccardi E, Cagliari E, Castellan L, Causin F, Ciceri E, Cirillo L, De Blasi R, Delehaye L, Di Paola F, Fontana A, Gasparotti R, Guidetti G, Divenuto I, Iannucci G, Isalberti M, Leonardi M, Lupo F, Mangiafico S, Manto A, Menozzi R, Muto M, Nuzzi NP, Papa R, Petralia B, Piano M, Resta M, Padolecchia R, Saletti A, Sirabella G, Bolge LP (2012) Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis. Neuroradiology 54:1145–1152
Briganti F, Napoli M, Leone G, Marseglia M, Mariniello G, Caranci F, Tortora F, Maiuri F (2014) Treatment of intracranial aneurysms by flow diverter devices: long-term results from a single center. Eur J Radiol 83:1683–1690
Brinjikji W, Lanzino G, Cloft HJ, Kallmes DF (2014) Patency of the posterior communicating artery after flow diversion treatment of internal carotid artery aneurysms. Clin Neurol Neurosurg 120:84–88
Chalouhi N, Zanaty M, Whiting A, Tjoumakaris S, Hasan D, Ajiboye N, Hann S, Rosenwasser RH, Jabbour P (2015a) Treatment of ruptured intracranial aneurysms with the pipeline embolization device. Neurosurgery 76:165–172
Chalouhi N, Zanaty M, Whiting A, Yang S, Tjoumakaris S, Hasan D, Starke RM, Hann S, Hammer C, Kung D, Rosenwasser R, Jabbour P (2015b) Safety and efficacy of the pipeline embolization device in 100 small intracranial aneurysms. J Neurosurg 122:1498–1502
Clarencon F, Di Maria F, Biondi A, Chiras J, Sourour NA (2013) Distant and delayed (>7 days) hemorrhage after treatment by flow-diverter stents in intracranial aneurysms: a rare but potentially serious complication. Am J Neuroradiol 34:E81–E82
Colby GP, Lin LM, Paul AR, Huang J, Tamargo RJ, Coon AL (2012) Cost comparison of endovascular treatment of anterior circulation aneurysms with the pipeline embolization device and stent-assisted coiling. Neurosurgery 71:944–948, Discussion 948–950
Cruz JP, Chow M, O’Kelly C, Marotta B, Spears J, Montanera W, Fiorella D, Marotta T (2012) Delayed ipsilateral parenchymal hemorrhage following flow diversion for the treatment of anterior circulation aneurysms. Am J Neuroradiol 33:603–608
Cummings TJ, Johnson RR, Diaz FG, Michael DB (2000) The relationship of blunt head trauma, subarachnoid hemorrhage, and rupture of pre-existing intracranial saccular aneurysms. Neurol Res 22:165–170
Fang S, Brinjikji W, Murad MH, Kallmes DF, Cloft HJ, Lanzino G (2014) Endovascular treatment of anterior communicating artery aneurysms: a systematic review and meta-analysis. Am J Neuroradiol 35:943–947
Gao BL, Safain MG, Malek AM (2015) Enterprise stenting for intracranial aneurysm treatment induces dynamic and reversible age-dependent stenosis in cerebral arteries. J Neurointerv Surg 7:297–302
Gonzalez AM, Narata AP, Yilmaz H, Bijlenga P, Radovanovic I, Schaller K, Lovblad KO, Pereira VM (2014) Blood blister-like aneurysms: single center experience and systematic literature review. Eur J Radiol 83:197–205
Kallmes DF, Hanel R, Lopes D, Boccardi E, Bonafe A, Cekirge S, Fiorella D, Jabbour P, Levy E, McDougall C, Siddiqui A, Szikora I, Woo H, Albuquerque F, Bozorgchami H, Dashti SR, Almandoz JED, Kelly ME, Turner R, Woodward BK, Brinjikji W, Lanzino G, Lylyk P (2015) International retrospective study of the pipeline embolization device: a multicenter aneurysm treatment study. Am J Neuroradiol 36:108–115
Kang HB, Peng TM, Qian ZH, Li YX, Jiang CH, Ji WJ, Wu J, Xu WJ, Wen XL, Liu AH (2015) Impact of hypertension and smoking on the rupture of intracranial aneurysms and their joint effect. Neurol Neurochir Pol 49:121–125
Keskin F, Erdi F, Kaya B, Poyraz N, Keskin S, Kalkan E, Ozbek O, Koc O (2015) Endovascular treatment of complex intracranial aneurysms by pipeline flow-diverter embolization device: a single-center experience. Neurol Res 37:359–365
Kocer N, Islak C, Kizilkilic O, Kocak B, Saglam M, Tureci E (2014) Flow re-direction endoluminal device in treatment of cerebral aneurysms: initial experience with short-term follow-up results. J Neurosurg 120:1158–1171
Korja M, Lehto H, Juvela S (2014) Lifelong rupture risk of intracranial aneurysms depends on risk factors a prospective Finnish cohort study. Stroke 45:1958–1963
Kotowski M, Naggara O, Darsaut TE, Nolet S, Gevry G, Kouznetsov E, Raymond J (2013) Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011. J Neurol Neurosurg Psychiatry 84:42–48
Lebedev V, Kuksova N, Krylov V, Miatchin M (1988) The information value of the EEG in the acute period of subarachnoid hemorrhage as a consequence of rupture of intracranial aneurysms. Zhurnal voprosy neirokhirurgii imeni NN Burdenko: 44–49
Leonardi M, Cirillo L, Toni F, Dall’Olio M, Princiotta C, Stafa A, Simonetti L, Agati R (2011) Treatment of intracranial aneurysms using flow-diverting silk stents (BALT): a single centre experience. Interv Neuroradiol 17:306–315
Lin L-M, Colby GP, Kim JE, Huang J, Tamargo RJ, Coon AL (2013) Immediate and follow-up results for 44 consecutive cases of small (<10 mm) internal carotid artery aneurysms treated with the pipeline embolization device. Surgical Neurology International 4
Lubicz B, Collignon L, Raphaeli G, De Witte O (2011) Pipeline flow-diverter stent for endovascular treatment of intracranial aneurysms: preliminary experience in 20 patients with 27 aneurysms. World Neurosurg 76:114–119
Malatesta E, Nuzzi NP, Divenuto I, Fossaceca R, Lombardi M, Cerini P, Guzzardi G, Stecco A, Andreula C, Carriero A (2013) Endovascular treatment of intracranial aneurysms with flow-diverter stents: preliminary single-centre experience. Radiol Med 118:971–983
McLaughlin N, McArthur DL, Martin NA (2013) Use of stent-assisted coil embolization for the treatment of wide-necked aneurysms: a systematic review. Surgical Neurology International 4
Olivo SA, Macedo LG, Gadotti IC, Fuentes J, Stanton T, Magee DJ (2008) Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther 88:156–175
Pandit S, Biswas TK, Debnath PK, Saha AV, Chowdhury U, Shaw BP, Sen S, Mukherjee B (1999) Chemical and pharmacological evaluation of different ayurvedic preparations of iron. J Ethnopharmacol 65:149–156
Shapiro M, Becske T, Sahlein D, Babb J, Nelson PK (2012) Stent-supported aneurysm coiling: a literature survey of treatment and follow-up. Am J Neuroradiol 33:159–163
Skukalek SL, Winkler AM, Kang J, Dion JE, Cawley CM, Webb A, Dannenbaum MJ, Schuette AJ, Asbury B, Tong FC (2014) Effect of antiplatelet therapy and platelet function testing on hemorrhagic and thrombotic complications in patients with cerebral aneurysms treated with the pipeline embolization device: a review and meta-analysis. J Neurointerv Surg
Sundram-Novelend SY, Appleton DS, Screaton NJ, Davies RJ, Chilvers ER (2008) Spontaneous rupture of an intercostal artery aneurysm during air flight. Thorax 63:294
Tahtinen OI, Manninen HI, Vanninen RL, Seppanen J, Niskakangas T, Rinne J, Keski-Nisula L (2012) The silk flow-diverting stent in the endovascular treatment of complex intracranial aneurysms: technical aspects and midterm results in 24 consecutive patients. Neurosurgery 70:617–624
Toma AK, Robertson F, Wong K, Joshi Y, Haridas A, Grieve J, Watkins LD, Kitchen ND, Brew S (2013) Early single centre experience of flow diverting stents for the treatment of cerebral aneurysms. Br J Neurosurg 27:622–628
Woo D, Hornung R, Sauerbeck L, Brown R, Meissner I, Huston J, Foroud T, Broderick J, Invest F (2009) Age at intracranial aneurysm rupture among generations Familial Intracranial Aneurysm Study. Neurology 72:695–698
Zanaty M, Chalouhi N, Starke RM, Barros G, Saigh MP, Schwartz EW, Ajiboye N, Tjoumakaris SI, Hasan D, Rosenwasser RH, Jabbour P (2014) Flow diversion versus conventional treatment for carotid cavernous aneurysms. Stroke 45:2656–2661
Zhou Y, Yang PF, Fang YB, Xu Y, Hong B, Zhao WY, Li Q, Zhao R, Huang QH, Liu JM (2014) A novel flow-diverting device (Tubridge) for the treatment of 28 large or giant intracranial aneurysms: a single-center experience. Am J Neuroradiol 35:2326–2333
Zhou G, Su M, Zhu YQ, Li MH (2015) Efficacy of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis. World Neurosurgery
Acknowledgments
The project was supported by the National Natural Scientific Foundation of China (No. 81141088) and by the Promotive Research Fund for Excellent Young and Middle-Aged Scientists of Shandong Province (No. 2004BS02010).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflicts of interest.
Rights and permissions
About this article
Cite this article
Ye, G., Zhang, M., Deng, L. et al. Meta-Analysis of the Efficiency and Prognosis of Intracranial Aneurysm Treated with Flow Diverter Devices. J Mol Neurosci 59, 158–167 (2016). https://doi.org/10.1007/s12031-016-0723-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12031-016-0723-x