背景:治疗基底尖动脉瘤(BAA)的血管内选择是异质的,证据仅限于回顾性队列和病例系列。我们试图评估与各种血管内治疗方法相关的BAA的疗效和并发症。
方法:PubMed的系统评价,Embase,和WebofScience坚持PRISMA准则。纳入2010年1月至2024年7月期间评估BAA血管内治疗的回顾性和前瞻性研究。相关信息,包括闭塞率,动脉瘤复发,再治疗率,和并发症进行荟萃分析。
结果:纳入了15项1,049个BAAs的研究。动脉瘤的中位直径为8.5mm(范围为4.6-19.75),中位随访时间为33.7个月(范围6.0-117.6)。在初次盘绕后,残留的动脉瘤充盈发生率为24%(95%CI=0.16-0.32),单支架辅助卷绕后25%(s-SAC;95%CI=0.04-0.46),Y型支架置入后25%(95%CI=0.12-0.37),分流支架置入后为23%(FDS;95%CI=0.11-0.35)。初次卷取的复发率很高(27%,95%CI=0.18-0.36)和s-SAC(19%,95%CI=0.13-0.26),但Y支架显著降低(9%,95%CI=0.03-0.15)和FDS(4%,95%CI=-0.04-0.11)。一次卷取的复治率为19%(95%CI=0.12-0.26),S-SAC为17%(95%CI=0.07-0.27),5%的Y支架(95%CI=-0.03-0.12),FDS为13%(95%CI=-0.01-0.27)。Meta回归显示较大的动脉瘤有较高的并发症发生率(p=0.02)。FDS和Y支架置入术中血栓栓塞事件最常见(12%)。
结论:不同治疗组的闭塞率相似,但与原发性卷绕相比,Y型支架置入和FDS治疗后的复发率明显较低,尽管他们携带更多的血栓栓塞并发症。
BACKGROUND: Endovascular options for the treatment of basilar apex aneurysms (BAAs) are heterogeneous, and evidence is limited to retrospective cohorts and case series. We seek to evaluate the efficacy and complications associated with various endovascular treatment methods of BAAs.
METHODS: Systematic review of PubMed, Embase, and Web of Science adhering to the PRISMA guidelines. Retrospective and prospective studies evaluating endovascular treatment of BAAs between January 2010 and July 2024 were included. Relevant information including occlusion rates, aneurysm recurrence, retreatment rates, and complications were subjected to meta-analysis.
RESULTS: Fifteen studies with 1,049 BAAs were included. The median aneurysm diameter was 8.5 mm (range 4.6-19.75), with a median follow-up of 33.7 months (range 6.0-117.6). Residual aneurysm filling occurred in 24% after primary
coiling (95% CI=0.16-0.32), 25% after single stent-assisted
coiling (s-SAC; 95% CI=0.04-0.46), 25% after Y-stenting (95% CI=0.12-0.37), and 23% after flow diverter stenting (FDS; 95% CI=0.11-0.35). Recurrence rates were high for primary
coiling (27%, 95% CI=0.18-0.36) and s-SAC (19%, 95% CI=0.13-0.26), but significantly lower for Y-stenting (9%, 95% CI=0.03-0.15) and FDS (4%, 95% CI=-0.04-0.11). Retreatment rates were 19% for primary
coiling (95% CI=0.12-0.26), 17% for s-SAC (95% CI=0.07-0.27), 5% for Y-stenting (95% CI=-0.03-0.12), and 13% for FDS (95% CI=-0.01-0.27). Meta-regression indicated larger aneurysms had higher complication rates (p=0.02). Thromboembolic events were most frequent with FDS and Y-stenting (12%).
CONCLUSIONS: Occlusion rates were similar across treatments, but recurrence rates were significantly lower after Y-stenting and FDS treatments compared to primary
coiling, although they carried a higher number of thromboembolic complications.