背景:颅内真菌或感染性动脉瘤是由动脉壁感染引起的,大多数由细菌或真菌引起。这些感染会削弱动脉壁,导致动脉瘤的形成,局部扩张,或者凸起。管理可以是保守的,主要基于抗生素或侵入性方法,例如夹闭或血管内治疗。
目的:我们对目前关于霉菌性动脉瘤血管内治疗的文献进行了系统综述和荟萃分析,分析与此程序相关的安全性和有效性。
方法:我们系统地搜索了PUBMED,科克伦图书馆,Embase,和WebofScience数据库。我们的搜索策略是精心制定的,目的是对该主题进行彻底的调查,利用相关关键词的综合组合。这项荟萃分析包括所有报道了血管内治疗霉菌性动脉瘤的研究。为了最大限度地降低偏见的风险,少于四名患者的研究,没有找到主要结果的研究,并且排除了显微外科手术和血管内治疗之间没有明确区别的研究。
结果:在对134例患者的综合分析中,据观察,除一名患者外,所有患者均接受抗生素作为治疗的一部分.在患者中,56%(90例患者中共有51例)行心脏手术。此外,3例患者在血管内治疗后需要开颅手术.12名患者经历了与所执行程序相关的发病率,表明干预措施引起的并发症。此外,4个动脉瘤在治疗时出现再出血.对霉菌性动脉瘤的血管内治疗的汇总分析显示了良好的技术成功水平。14项研究中有12项成功率达到100%(97-100%;CI95%;I2=0%),如图所示。2.同样,动脉瘤闭塞率表现出显著的疗效,14项研究中有12项的成功率为97%(97-100%;CI95%;I2=0%),如图所示。3.
结论:结果强烈支持血管内治疗在取得技术成功方面的功效。动脉瘤完全闭塞,和良好的神经系统结果。此外,并发症发生率和手术相关死亡率明显较低,再次证明了该干预措施的安全性和获益.
Intracranial mycotic or infectious aneurysms result from the infection of arterial walls, most caused by bacterial or fungal organisms. These infections can weaken the arterial wall, leading to the formation of an aneurysm, a localized dilation, or a bulge. The management can be conservative mainly based on antibiotics or invasive methods such as clipping or endovascular treatment.
We performed a systematic review and meta-analysis of the current literature on endovascular treatment of mycotic aneurysms, analyzing the safety and efficacy associated with this procedure.
We systematically searched on PUBMED, Cochrane Library, Embase, and Web of Science databases. Our search strategy was carefully crafted to conduct a thorough investigation of the topic, utilizing a comprehensive combination of relevant keywords. This meta-analysis included all studies that reported endovascular treatment of mycotic aneurysms. To minimize the risk of bias, studies with fewer than four patients, studies where the main outcome was not found, and studies with no clear differentiation between microsurgical and endovascular treatment were excluded.
In a comprehensive analysis of 134 patients, it was observed that all except one patient received antibiotics as part of their treatment. Among the patients, 56% (a total of 51 out of 90 patients) underwent cardiac surgery. Additionally, three patients required a craniotomy following endovascular treatment. 12 patients experienced morbidity related to the procedures performed, indicating complications arising from the interventions. Furthermore, four aneurysms experienced rebleeding while treatment. A pooled analysis of the endovascular treatment of the mycotic aneurysm revealed a good level of technical success, achieving a 100% success rate in 12 out of 14 studies (97-100%; CI 95%; I2 = 0%), as illustrated in Fig. 2. Similarly, the aneurysm occlusion rate demonstrated a notable efficacy, with a success rate of 97% observed in 12 out of 14 studies (97-100%; CI 95%; I2 = 0%), as depicted in Fig. 3.
The results strongly support the efficacy of endovascular treatment in achieving technical success, complete aneurysm occlusion, and favorable neurological outcomes. Additionally, the notably low incidence of complications and procedure-related mortality reaffirms the safety and benefits associated with this intervention.