背景:颅内动脉瘤(EVTIA)的血管内治疗由于其微创性和高成功率而越来越受欢迎。虽然全身麻醉(GA)一直是EVTIA的历史首选,人们对局部麻醉(LA)的兴趣与日俱增。然而,人们对EVTIA的洛杉矶安全仍然存在担忧。因此,我们进行了系统评价和荟萃分析,以评估EVTIA的LA安全性.
方法:遵循PRISMA指南,我们搜索了PubMed,Embase,和WebofScience数据库。具有95%置信区间(CI)评估效果的汇集分析,I2统计数据衡量了异质性,并采用随机效应模型。转换为GA,神经系统或手术相关并发症,术中颅内出血并发症(IIHC),和死亡率进行了评估。对破裂和未破裂病例进行亚分析。
结果:分析包括11项研究,2,133名患者,和2,369名洛杉矶雇员。GA转化率为1%(95CI:0至2%)。神经系统或手术相关并发症发生率为13%(95%CI:8%-17%)。IIHC分析显示比率为1%(95%CI:1%至2%)。死亡率为0%(95CI:0%至0%)。亚分析显示破裂和未破裂亚组的发生率相似,除了破裂亚组的并发症和IIHC发生率略高。
结论:研究结果表明,LA下的EVTIA是安全的,转化率和死亡率低,即使是破裂的动脉瘤.并发症发生率,在IIHC费率中,与GA的报告相当,强调洛杉矶在EVTIA中的可比安全性。考虑到这些有希望的结果,选择LA入路的决定是有意义的,非常适合动脉瘤的血管内治疗.除了安全之外,洛杉矶引入了固有的补充优势,包括缩短住院时间,成本效益,和加快患者康复过程。
BACKGROUND: Endovascular treatment of intracranial aneurysms (EVTIAs) is increasingly popular due to its minimally invasive nature and high success rate. While general anesthesia (GA) has been the historical preference for EVTIAs, there\'s growing interest in local anesthesia (LA). However, concerns persist about LA safety for EVTIAs. Therefore, we conducted a systematic
review and meta-analysis to assess LA safety for EVTIAs.
METHODS: Following PRISMA guidelines, we searched PubMed, Embase, and Web of Science databases. Pooled analysis with 95 % confidence intervals (CI) assessed effects, I2 statistics gauged heterogeneity, and a random-effects model was adopted. Conversion to GA, neurological or procedure-related complications, intraoperative intracranial hemorrhagic complications (IIHC), and mortality were assessed. Subanalyses for ruptured and unruptured cases were performed.
RESULTS: The analysis included eleven studies, 2,133 patients, and 2,369 EVTIAs under LA. Conversion to GA rate was 1 % (95 %CI: 0 to 2 %). Neurological or procedure-related complications rate was 13 % (95 % CI: 8 % to 17 %). IIHC analysis revealed a rate of 1 % (95 % CI: 1 % to 2 %). The mortality rate was 0 % (95 %CI: 0 % to 0 %). Subanalyses revealed similar rates in ruptured and unruptured subgroups, except for a slightly high rate of complications and IIHC in the ruptured subgroup.
CONCLUSIONS: Findings indicate that EVTIA under LA is safe, with low conversion and mortality rates, even for ruptured aneurysms. Complications rates, also in IIHC rates, are comparable to those reported for GA, emphasizing LA\'s comparable safety profile in EVTIAs. Considering these promising outcomes, the decision to opt for the LA approach emerges as meaningful and well-suited for the endovascular treatment of aneurysms. Beyond its safety, LA introduces inherent supplementary advantages, including shortened hospitalization periods, cost-effectiveness, and an expedited patient recovery process.