目的:假性动脉瘤(PSA)是复杂的血管病变。已提出流量转移作为保留层流的母体动脉闭塞的替代治疗。本研究的作者调查了使用Pipeline栓塞装置(PED)治疗颅内和颅外PSA后的安全性和短期(<1年)和长期(≥1年)动脉瘤闭塞率。
方法:通过电子数据库搜索OvidMEDLINE和Epub的全文英文文章,OvidEmbase,OvidCochrane中央控制试验登记册,OvidCochrane系统评价数据库,Scopus是按照PRISMA指南进行的。该分析包括任何设计的研究,包括至少4名使用PED治疗的颅内或颅外PSA患者。感兴趣的主要结果是围手术期和术后并发症的发生率。其次,作者分析了动脉瘤完全闭塞的发生率。
结果:在9项研究中,共纳入90例患者,96例PSA。平均年龄为38.2(SD15.14)岁,37.8%的患者是女性。平均PSA尺寸为4.9mm。大多数PSA没有破裂,最常见的病因是外伤(n=32,35.5%),其次是自发形成(n=21,23.3%)和医源性损伤(n=19,21.1%)。在51例(53.1%)颅内和45例(46.9%)颅外PSA中,有19例(19.8%)解剖PSA。颈内动脉有66例(77.6%)PSA,椎动脉有10例(11.8%)。33例(34.4%)PSA用≥2台装置治疗,8人(8.3%)接受了辅助卷绕。平均临床和血管造影随访时间为10.7和12.9个月,分别。短期(<1年)和长期(≥1年)完全闭塞率为79%(95%CI66%-88%,p=0.82)和84%(95%CI70%-92%,p=0.95),分别。医源性夹层的并发症率为8%(95%CI3%-16%,p=0.94),10%用于无症状血栓栓塞(95%CI5%-21%,p=0.77),症状性血栓栓塞为12%(95%CI6%-23%,p=0.48)。未观察到治疗相关的出血。最后一次随访的总死亡率为14%。
结论:用PED治疗的PSA的完全闭塞率很高,并且随着时间的推移而增加。尽管术后并发症和死亡率并非微不足道,分流是管理这些复杂病变的合理安全选择。
Pseudoaneurysms (PSAs) are complex vascular lesions. Flow diversion has been proposed as an alternative treatment to parent artery occlusion that preserves laminar flow. The authors of the present study investigated the safety and short-term (< 1 year) and long-term (≥ 1 year) aneurysm occlusion rates following the treatment of intracranial and extracranial PSAs using the Pipeline embolization device (PED).
An electronic database search for full-text English-language articles in Ovid MEDLINE and Epub Ahead of Print, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus was conducted following the PRISMA guidelines. Studies of any design including at least 4 patients with intracranial or extracranial PSAs treated using a PED were included in this analysis. The primary outcome of interest was the rate of peri- and postprocedural complications. Secondarily, the authors analyzed the incidence of complete aneurysm occlusion.
A total of 90 patients with 96 PSAs across 9 studies were included. The mean age was 38.2 (SD 15.14) years, and 37.8% of the patients were women. The mean PSA size was 4.9 mm. Most PSAs were unruptured, and the most common etiology was trauma (n = 32, 35.5%), followed by spontaneous formation (n = 21, 23.3%) and iatrogenic injury (n = 19, 21.1%). Among the 51 (53.1%) intracranial and 45 (46.9%) extracranial PSAs were 19 (19.8%) dissecting PSAs. Sixty-six (77.6%) PSAs were in the internal carotid artery and 10 (11.8%) in the vertebral artery. Thirty-three (34.4%) PSAs were treated with ≥ 2 devices, and 8 (8.3%) underwent adjunctive coiling. The mean clinical and angiographic follow-up durations were 10.7 and 12.9 months, respectively. The short-term (< 1 year) and long-term (≥ 1 year) complete occlusion rates were 79% (95% CI 66%-88%, p = 0.82) and 84% (95% CI 70%-92%, p = 0.95), respectively. Complication rates were 8% for iatrogenic dissection (95% CI 3%-16%, p = 0.94), 10% for silent thromboembolism (95% CI 5%-21%, p = 0.77), and 12% for symptomatic thromboembolism (95% CI 6%-23%, p = 0.48). No treatment-related hemorrhage was observed. The overall mortality rate at the last follow-up was 14%.
The complete occlusion rate for PSAs treated with the PED was high and increased over time. Although postprocedural complications and mortality were not insignificant, flow diversion represents a reasonably safe option for managing these complex lesions.