■目前,颅内动脉瘤(ICAs)的血管内治疗受到低完全闭塞率的限制.新型血管内技术的出现扩大了血管内治疗的适用性;然而,与传统的Guglielmi可拆卸线圈(GDC)相比,新型栓塞装置的优越性仍存在争议。我们对文献进行了系统回顾,这些文献报道了现代血管内装置的Raymond-Roy闭塞分类(RROC)率,以确定其治疗未破裂的囊状ICA的即时和后续闭塞效果。
■使用电子数据库进行了搜索(PUBMED,科克伦,ClinicalTrials.gov,WebofScience)。我们检索了2000-2022年间发表的研究报告,报告了接受不同血管内ICA治疗的受试者的即时和随访RROC率。我们提取了接受治疗的患者的人口统计信息及其报告的血管造影RROC率。
■共有来自15个国家的80项研究被纳入数据提取。从血管造影中确定的RROC率获得了21,331例患者(72.5%女性,合并平均年龄:58.2(95%CI:56.8-59.6),有22,791个动脉瘤.最常见的动脉瘤位置是颈内动脉(46.4%,95%CI:41.9%-50.9%),前交通动脉(26.4%,95%CI:22.5%-30.8%),大脑中动脉(24.5%,95%CI:19.2%-30.8%)和基底动脉尖端(14.4%,95%CI:11.3%-18.3%)。分析GDC的完全闭塞概率(RROC-I),编织的Endobridge(WEB)和分流器。RROC-I率在球囊辅助卷取中最高(73.9%,95%CI:65.0%-81.2%),在WEB中最低(27.8%,95%CI:13.2%-49.2%)。在所有分析的装置中,后续RROC-I概率是均匀的。
■我们观察到基于线圈的血管内治疗提供了可接受的完全闭塞率,这些比率在球囊辅助线圈中得到改善。在分析的设备中,WEB表现出最短的时间来实现>90%的概率随访完全闭塞(约18个月)。总的来说,GDC仍是未破裂囊状动脉瘤血管内治疗的金标准.
UNASSIGNED: Currently, endovascular treatment of intracranial aneurysms (ICAs) is limited by low complete occlusion rates. The advent of novel endovascular technology has expanded the applicability of endovascular therapy; however, the superiority of novel embolic devices over the traditional Guglielmi detachable coils (GDCs) is still debated. We performed a systematic review of literature that reported Raymond-Roy occlusion classification (RROC) rates of modern endovascular devices to determine their immediate and follow-up occlusion effectiveness for the treatment of unruptured saccular ICAs.
UNASSIGNED: A search was conducted using electronic databases (PUBMED, Cochrane, ClinicalTrials.gov, Web of Science). We retrieved studies published between 2000-2022 reporting immediate and follow-up RROC rates of subjects treated with different endovascular ICA therapies. We extracted demographic information of the treated patients and their reported angiographic RROC rates.
UNASSIGNED: A total of 80 studies from 15 countries were included for data extraction. RROC rates determined from angiogram were obtained for 21,331 patients (72.5% females, pooled mean age: 58.2 (95% CI: 56.8-59.6), harboring 22,791 aneurysms. The most frequent aneurysm locations were the internal carotid artery (46.4%, 95% CI: 41.9%-50.9%), the anterior communicating artery (26.4%, 95% CI: 22.5%-30.8%), the middle cerebral artery (24.5%, 95% CI:19.2%-30.8%) and the basilar tip (14.4%, 95% CI:11.3%-18.3%). The complete occlusion probability (RROC-I) was analyzed for GDCs, the Woven EndoBridge (WEB), and flow diverters. The RROC-I rate was the highest in balloon-assisted coiling (73.9%, 95% CI: 65.0%-81.2%) and the lowest in the WEB (27.8%, 95% CI:13.2%-49.2%). The follow-up RROC-I probability was homogenous in all analyzed devices.
UNASSIGNED: We observed that the coil-based endovascular therapy provides acceptable rates of complete occlusion, and these rates are improved in balloon-assisted coils. Out of the analyzed devices, the WEB exhibited the shortest time to achieve >90% probability of follow-up complete occlusion (~18 months). Overall, the GDCs remain the gold standard for endovascular treatment of unruptured saccular aneurysms.