Abstract：
BACKGROUND: Direct carotid-cavernous fistulas (dCCFs) involve the abnormal shunting of blood between the internal carotid artery and the cavernous sinus. The use of covered stents (CSs) has been reported for the treatment of complex carotid artery lesions. However, the efficacy and safety of CS treatment for dCCFs remain controversial. Thus, we performed a systematic review and meta-analysis to evaluate these efficacy and safety endpoints.
METHODS: A systematic literature review was performed by comprehensively searching the Medline, Embase, and Web of Science databases to identify studies that were related to CS treatment for dCCFs. Then, a meta-analysis was conducted to pool the efficacy and safety outcomes from these studies based on perioperative and follow-up data.
RESULTS: Fourteen noncomparative studies enrolling 156 patients with 160 dCCFs met the inclusion criteria. When analyzing perioperative outcomes, the technical success rate was 98.5% [95% confidence interval (CI), 0.948; 1.000], and the immediate complete occlusion rate was 90.9% (95% CI, 0.862; 0.959). Vasospasm and dissection occurred in 32.2% (95% CI, 0.238; 0.463) and 0.1% (95% CI, 0.000; 0.012) of patients, respectively. The in-stent acute thrombus formation rate was 0.1% (95% CI, 0.000; 0.013). Postoperatively, the mortality rate was 0.1% (95% CI, 0.000; 0.013). Based on available follow-up data, the final complete occlusion and parent artery stenosis rates were 99.3% (95% CI, 0.959; 1.000) and 18.6% (95% CI, 0.125; 0.277), respectively.
CONCLUSIONS: CS placement can be used to safely and effectively treat dCCFs. These results provide a reference for future clinical trials.
METHODS: A systematic literature review was performed by comprehensively searching the Medline, Embase, and Web of Science databases to identify studies that were related to CS treatment for dCCFs. Then, a meta-analysis was conducted to pool the efficacy and safety outcomes from these studies based on perioperative and follow-up data.
RESULTS: Fourteen noncomparative studies enrolling 156 patients with 160 dCCFs met the inclusion criteria. When analyzing perioperative outcomes, the technical success rate was 98.5% [95% confidence interval (CI), 0.948; 1.000], and the immediate complete occlusion rate was 90.9% (95% CI, 0.862; 0.959). Vasospasm and dissection occurred in 32.2% (95% CI, 0.238; 0.463) and 0.1% (95% CI, 0.000; 0.012) of patients, respectively. The in-stent acute thrombus formation rate was 0.1% (95% CI, 0.000; 0.013). Postoperatively, the mortality rate was 0.1% (95% CI, 0.000; 0.013). Based on available follow-up data, the final complete occlusion and parent artery stenosis rates were 99.3% (95% CI, 0.959; 1.000) and 18.6% (95% CI, 0.125; 0.277), respectively.
CONCLUSIONS: CS placement can be used to safely and effectively treat dCCFs. These results provide a reference for future clinical trials.
摘要：
背景：直接颈动脉海绵窦瘘（dCCF）涉及颈内动脉和海绵窦之间的异常血液分流。据报道，使用覆膜支架（CSs）治疗复杂的颈动脉病变。然而,CS治疗dCCF的有效性和安全性仍存在争议.因此，我们进行了系统评价和荟萃分析,以评估这些疗效和安全性终点.
方法：通过全面搜索Medline进行了系统的文献综述，Embase,和WebofScience数据库，以确定与CS治疗dCCF相关的研究。然后，我们基于围手术期和随访数据,进行了一项荟萃分析,以汇集这些研究的疗效和安全性结局.
结果：14项非比较研究纳入156例160dCCF患者符合纳入标准。在分析围手术期结果时，技术成功率为98.5%[95%置信区间(CI)，0.948,1.000],即刻完全闭塞率为90.9%(95%CI,0.862,0.959)。32.2%(95%CI,0.238,0.463)和0.1%(95%CI,0.000,0.012)的患者发生血管痉挛和夹层,分别。支架内急性血栓形成率为0.1%(95%CI,0.000;0.013)。术后,死亡率为0.1%(95%CI,0.000,0.013).根据现有的随访数据，最终完全闭塞和父动脉狭窄率分别为99.3%(95%CI,0.959,1.000)和18.6%(95%CI,0.125,0.277),分别。
结论：CS放置可以安全有效地治疗dCCF。这些结果为今后的临床试验提供了参考。
方法：通过全面搜索Medline进行了系统的文献综述，Embase,和WebofScience数据库，以确定与CS治疗dCCF相关的研究。然后，我们基于围手术期和随访数据,进行了一项荟萃分析,以汇集这些研究的疗效和安全性结局.
结果：14项非比较研究纳入156例160dCCF患者符合纳入标准。在分析围手术期结果时，技术成功率为98.5%[95%置信区间(CI)，0.948,1.000],即刻完全闭塞率为90.9%(95%CI,0.862,0.959)。32.2%(95%CI,0.238,0.463)和0.1%(95%CI,0.000,0.012)的患者发生血管痉挛和夹层,分别。支架内急性血栓形成率为0.1%(95%CI,0.000;0.013)。术后,死亡率为0.1%(95%CI,0.000,0.013).根据现有的随访数据，最终完全闭塞和父动脉狭窄率分别为99.3%(95%CI,0.959,1.000)和18.6%(95%CI,0.125,0.277),分别。
结论：CS放置可以安全有效地治疗dCCF。这些结果为今后的临床试验提供了参考。
