Whether Intracranial Aneurysm Could Be Well Treated by Flow Diversion: A Comprehensive Meta-Analysis of Large-Sample Studies including Anterior and Posterior Circulation

Abstract

Background. Flow diversion (FD) has become a widely adopted treatment method for intracranial aneurysms in the clinic, but a comprehensive meta-analysis of large-sample studies including anterior and posterior circulation is still lacking. Methods. The PubMed, Embase, Web of Science, and Cochrane databases were searched between January 1, 2008, and December 1, 2019. A random-effect model was used to calculate the efficacy and safety data as well as 95% confidence intervals (CIs). Results. The pooled sample size of all included studies was 6695 patients; the mean age was 55.5 years old, with a total of 7406 aneurysms. For efficacy, the complete occlusion rate in angiographic follow-up (AFU) at 6 months was 78% (95% CI, 0.77, 0.80), and the AFU rate at 6-12 months was 90% (95% CI, 0.88, 0.92). For safety, the hemorrhagic event rate was 2%, the ischemic event rate was 5%, and the mortality rate was 3%. Conclusion. FD is an effective and safe treatment for intracranial aneurysm with high complete occlusion rate and acceptable complication rate.

Clinical Usage of Different Doses of Cis-Atracurium in Intracranial Aneurysm Surgery and Its Effect on Motor-Evoked Potentials

“…When the blood arteries in the head narrow and spasm, the blood flow rate slows, increasing the risk of a head blood vessel infarction. In addition, patients may also experience hemiplegia, aphasia, intellectual disability, and movement disorders [14][15][16]. Unfortunately, these conventional treatments all have many difficulties for giant intracranial aneurysms, such as huge aneurysm, thin wall, easy rupture and bleeding, wide aneurysm neck, difficult or impossible to clip.…”

Aneurismas Cerebrais: Uma Abordagem Abrangente Desde Os Mecanismos De Formação Até as Estratégias Terapêuticas Modernas, Incluindo Diagnóstico Por Imagem E Intervenções Cirúrgicas

“…Finalmente, uma meta-análise abrangente avaliou o desvio de fluxo como tratamento para aneurismas intracranianos, encontrando alta taxa de oclusão completa e complicações aceitáveis. Isso sugere que o desvio de fluxo é uma opção eficaz e segura 6 .…”

Effects of the flow diversion technique on nucleotide levels in intra-cranial aneurysms: A feasibility study providing new research perspectives

“…The flow diversion technique has revolutionized the treatment of large and complex IAs that were difficult (or even impossible) to treat with previous techniques. Compared with conventional techniques (i.e., coiling, stent-assisted coiling, parent vessel occlusion, or surgical clipping), FDSs showed higher rates of occlusion and lower rates of recurrence without increasing the rate of complications in the treatment of specific aneurysms, such as giant or complex aneurysms (3,4,15). Their efficacy relies on the ability to redirect the blood flow out of the aneurysmal sac, thus decreasing the intra-aneurysmal blood flow and the endothelization of the aneurysm neck, hence promoting thrombosis of the aneurysm and its regression (2).…”

“…The aneurysm cure results from intra-saccular thrombosis are favored by this technique and therefore are not immediate but progressive. Indeed, a recent meta-analysis has reported complete occlusion rates of 68% (65–72%) and 90% (88–92%) with this technique in follow-up before 6 months and at 6–12 months, respectively ( 3 , 4 ).…”

“…Numerous studies exploring these two mechanisms have improved the understanding of this technique ( 2 , 7 – 9 ). However, they have not provided a comprehensive picture of the flow diversion effect that may explain why as many as 10% of IAs treated with FDSs remain patent at 1-year follow-up ( 4 ).…”