Safety Evaluation and Flow Modification in the Anterior Cerebral Artery after Pipeline Embolization Device Deployment across the Internal Carotid Artery Terminus

Xu, Chao; Wu, Pei; Han, Jianyi; Sun, Bowen; Wang, Chunlei; Xu, Shuai; Luo, Bin; Yang, Xinjian; Mu, Qingchun; Shi, Huaizhang

doi:10.1155/2021/6657595

Cited by 2 publications

(10 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 57 studies 9 – 65 , encompassing 4647 records, involved 3789 patients with IA who were treated using FDSs. These studies employed a nonrandomized comparative design; the selection process is shown in Figure S1 (Supplemental Digital Content 2, http://links.lww.com/JS9/B226 ).…”

Section: Resultsmentioning

confidence: 99%

“…Among 50 studies 9 – 19 , 22 , 23 , 25 – 35 , 37 – 47 , 49 , 50 , 52 – 63 , 65 involving 3100 patients, the overall obliteration rate was 77.5% (95% CI: 74.0–80.9%; I 2 , 69.8%; Table S3, Supplemental Digital Content 2, http://links.lww.com/JS9/B226 , Figure S2, Supplemental Digital Content 2, http://links.lww.com/JS9/B226 ). Subgroup analyses indicated a high obliteration rate regardless of the specific branches covered by FDSs (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies 44 , 51 reported an occlusion rate of 59.1% (13/22) at the final follow-up when the FDSs covered PICA branches. After excluding the two studies 39 , 58 , a total of 97.4% of patients (95% CI: 95.5–98.8%; I 2 , 54.3%, Table S4, Supplemental Digital Content 2, http://links.lww.com/JS9/B226 and Figure S5, Supplemental Digital Content 2, http://links.lww.com/JS9/B226 ) showed an ideal clinical outcome, albeit with large heterogeneity 10 , 11 , 14 , 16 , 17 , 19 , 20 , 22 , 29 , 35 , 38 , 41 , 42 , 45 , 46 , 50 , 55 – 58 , 60 , 65 . Subgroup analysis indicated a relatively lower heterogeneity among studies in America (rate, 95.3%; 95% CI: 91.9–97.9%; I 2 , 0.0%) and Europe (rate, 96.5%; 95% CI: 90.6–99.9%; I 2 , 44.0%), compared to those in Asia (rate, 98.4%; 95% CI: 94.0–100.0%; I 2 , 85.5%, Fig.…”

Section: Resultsmentioning

confidence: 99%

“…After implantation of FDSs covering branches, the overall rate of branch occlusion/narrowing was 26.2% (95% CI: 19.8–33.1%; Figure S6A, Supplemental Digital Content 2, http://links.lww.com/JS9/B226 ) 9 – 65 . Due to publication bias (Egger’s test with P <0.001), the adjusted rate was 14.5% (95% CI: 8.4–21.8%; Table S5, Supplemental Digital Content 2, http://links.lww.com/JS9/B226 and Figure S6D, Supplemental Digital Content 2, http://links.lww.com/JS9/B226 ).…”

Section: Resultsmentioning

confidence: 99%

“…Due to publication bias (Egger’s test with P <0.001), the adjusted rate was 14.5% (95% CI: 8.4–21.8%; Table S5, Supplemental Digital Content 2, http://links.lww.com/JS9/B226 and Figure S6D, Supplemental Digital Content 2, http://links.lww.com/JS9/B226 ). The pooled rate of branch occlusion-related symptoms (per patient) among 50 included studies 9 – 30 , 32 – 42 , 44 , 46 , 47 , 49 – 52 , 54 , 56 , 58 – 65 was 1.8% (95% CI: 0.1–3.0%; Table S6, Supplemental Digital Content 2, http://links.lww.com/JS9/B226 and Figure S7, Supplemental Digital Content 2, http://links.lww.com/JS9/B226 ). Despite the use of subgroup analysis and the omission of several studies, the large heterogeneity remained unresolved.…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Flow-diverter stents in intracranial aneurysm treatment: impact on covered cerebral artery branches

Liu,

Cao,

Zhenmei

et al. 2023

International Journal of Surgery

View full text Add to dashboard Cite

Objective: Flow diverter stents (FDSs) have attracted interest for intracranial aneurysm (IA) treatment; however, occlusion of side branches and related complications have been reported. This study aimed to investigate the effects of FDSs in IA management when different branches of intracranial arteries are covered. Materials and methods A cross-sectional study was conducted using PUBMED, Embase, Web of Science, and Cochrane databases to include randomized or non-randomized comparative designed studies from January 2000 to August 2022 which reported outcomes of occlusion/narrowing of branches after IA treatment using FDSs. The PRISMA guidelines were used for data abstraction and assessing data quality and validity. Random-effects meta-analysis was conducted to pool the outcomes included incidence rates of occlusion/narrowing of FDS-covered branches, branch occlusion-related symptoms, obliteration of IAs, and ideal clinical outcomes (modified Rankin Scale score ≤ 2). Results: We identified 57 studies involving 3789 patients with IA managed by FDSs covering different branches. During the median imaging follow-up at 12 months, the IA obliteration rate was satisfactory (>70%) when covering the ophthalmic artery (OA), posterior communicating artery (PComA), anterior choroidal artery (AChoA) or anterior cerebral artery (ACA), but not the middle cerebral artery-M2 segment (MCA-M2; 69.5%; 95% CI, 50.8%–77.5%) and posterior inferior cerebellar artery (PICA; 59.1%, 13/22). The overall ideal clinical outcome was observed in 97.4% of patients (95% CI, 95.5%–98.9%). Higher rates of occlusion/narrowing of branches were identified when FDSs covered the ACA (66.6%; 95% CI, 45.1%–85.3%), PComA (44.3%; 95% CI, 34.2%–54.6%), or MCA-M2 (39.2%; 95% CI, 24.5%–40.8%); the risks were lower when covering the OA (13.0%; 95% CI, 9.7%–16.7%), PICA (6.8%; 95% CI, 1.5%–14.5%), and AchoA (0.5%; 95% CI, 0.0%–2.9%). The risk of branch-occlusion-related complications was low (incidence rate <5%) for each of the six evaluated branches. Conclusions: Acceptable outcomes were identified following treatment of IAs when FDSs were placed across each of the six studied cerebral arteries. Treatment decisions regarding FDS placement across branch arteries should be made with the risk of complications from branch occlusion in mind.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Flow-diverter stents in intracranial aneurysm treatment: impact on covered cerebral artery branches

Liu,

Cao,

Zhenmei

et al. 2023

International Journal of Surgery

View full text Add to dashboard Cite

show abstract

Effect of the pipeline embolization device placement on branching vessels in anterior circulation: a systematic review and meta-analysis

He,

Sun,

Han

et al. 2024

Acta Neurochir

View full text Add to dashboard Cite

Background and purpose Pipeline embolization device (PED) is widely used in intracranial aneurysms, and the scope of applications for the PED, which is frequently used to treat cerebral aneurysms, is also growing. It has some effect on branching vessels as a result of its inherent properties. The effects of PED on the complications rate and branching vessels blockage have not yet been thoroughly investigated. Objective We conducted a systematic review searching reports from multiple databases on PED use for intracranial aneurysms, and analyzed the influence of PED on the occlusion rate of different branching vessels, and the influence of the amount of PED on the occlusion rate of branching vessels by meta-analysis. Methods We searched the literature using PUBMED, Web of Science, and OVID databases until August 2023. Inclusion criteria were that the study used only PED, included at least 10 patients, and recorded branching vessels occlusion rates, mortality, and neurological complications. Results Nine studies were analyzed consisting of 706 patients with 986 side branches. The results of the meta-analysis showed that application of more than one PED did not significantly elevate the rate of branching vessels occlusion compared to application of one PED (OR = 0.70; 95% CI: 0.34 to 1.43; P = 0.33). In the comparison of branching vessels occlusion rates in the anterior circulation, the anterior cerebral artery (ACA) had a significantly higher occlusion rate compared to the ophthalmic artery (OphA) (OR = 6.54; 95% CI: 3.05 to 14.01; P < 0.01), ACA also had a higher occlusion rate compared to the anterior choroidal artery (AchA) (OR = 15.44; 95% CI: 4.11 to 57.94 P < 0.01), ACA versus posterior communicating artery (PcomA) occlusion rate difference was not statistically significant (OR = 2.58; 95% CI: 0.63 to 12.82; P = 0.17), OphA versus AchA occlusion rate difference was not statistically significant (OR = 2.56; 95% CI: 0.89 to 7.38; P = 0.08), and the occlusion rate was significantly higher for PcomA compared to AchA (OR = 7.22; 95% CI: 2.49 to 20.95; P < 0.01) and lower for OphA compared to PcomA (OR = 0.33; 95% CI: 0.19 to 0.55; P < 0.01). Conclusion The meta-analysis shows that use of multiple PEDs did not significantly increase the occlusion rate of branching vessels, and the larger the diameter of branching vessels covered by PED, the higher the occlusion rate of branching vessels. However, the incidence of complications is low after branching vessels occlusion in anterior circulation, which is related to the collateral circulation compensation of the branching vessels.

show abstract

Safety Evaluation and Flow Modification in the Anterior Cerebral Artery after Pipeline Embolization Device Deployment across the Internal Carotid Artery Terminus

Cited by 2 publications

References 22 publications

Flow-diverter stents in intracranial aneurysm treatment: impact on covered cerebral artery branches

Flow-diverter stents in intracranial aneurysm treatment: impact on covered cerebral artery branches

Effect of the pipeline embolization device placement on branching vessels in anterior circulation: a systematic review and meta-analysis

Contact Info

Product

Resources

About