Pipeline血流导向装置治疗颅内动脉瘤的Meta分析

Pipeline flow-diverter embolization device for intracranial aneurysms： a meta-analysis

目的通过Meta分析，探讨Pipeline栓塞装置（PED）治疗颅内动脉瘤的安全性与可行性。方法采用Cochrane系统评价法，通过Medline数据库、Embase数据库、Cochrane系统评价数据库、中国期刊全文数据库和WebofScience数据库，检索截至到2015年2月的文献。根据纳入与排除标准进行筛选。采用观察性流行病学研究报告规范（STROBE）的文献质量评价标准对纳入文献进行质量评价。对各研究患者及颅内动脉瘤的基线特征、PED术后闭塞率、安全事件发生率及相应人数、病死率及相应人数等数据进行析取。采用STATA12．0软件对闭塞率进行Meta分析，采用X2检验判断动脉瘤的类型与并发症发生率及病死率之间是否存在统计学意义。结果纳入的29篇文献包括1371例患者、1562个动脉瘤。纳入文献的STROBE评分为14．9分。PED术后平均随访时间为6．4个月，动脉瘤闭塞率为82．5％（95％口：78．3—86．8；r=74．2％），脑神经相关发病率为8．3％（114／1371），脑神经相关病死率为2．0％（27／1371）。自发性破裂的发生率为1．6％（22／1371），脑实质出血的发生率为2．1％（29／1371），缺血性卒中的发生率为42％（58／1371）。巨大型动脉瘤术后脑神经相关发病率高于小型和大型动脉瘤（X2=0．42，P〈0.05），病死率高于小型和大型动脉瘤∽=15．32，P〈0．05）；后循环动脉动脉瘤术后缺血眭卒中发生率高于前循环动脉动脉瘤（X2=8．50，P〈0．05）。闭塞率发表偏倚用Begg秩相关法，矫正后P值为0．011。结论Meta分析研究结果总体支持PED治疗颅内动脉瘤的安全性和可行性。PED术后有较高的闭塞率，严重并发症发生率较低。但是巨大型颅内动脉瘤存在较高的脑神经相关发病率及病死率，后循环动脉动脉瘤存在较高的缺血性卒中风险。

Objective To investigate the safety and feasibility of the pipeline embolization device （PED） for the treatment of intraeranial aneurysms. Methods Cochrane systematic reviews were used to retrieve relevant literature up to February 2015 through Medline, Embase, Coehrane Database of Systematic Reviews, China national knowledge infrastructure （CNKI）, and Web of Science database. The relevant literature was screened according to the inclusion and exclusion criteria. The Reporting of Observational Studies in Epidemiology （STROBE） was used to conduct quality evaluation for the included literature. The data including all the patients studied and the baseline characteristics of intracranial aneurysms, PED postoperative occlusion rate, incidence of safety incidents, corresponding number of patients, and case fatality rate and corresponding number of patients were extracted. Metaanalysis of the occlusion rate was conducted by using the STATA 12. 0 software. The chi-square test was used to identify whether there were significant differences between the aneurysm types and the incidence of complications or the mortality rate. Results A total of 29 studies and 1 371 patients with 1 562 aneurysms were enrolled. The mean STROBE score of the included literature was 14.9. The mean follow-up time was 6.4 months after PED procedure. The aneurysm occlusion rate was 82. 5% （95% Cl 78. 3 - 86. 8 ; 12 = 74. 2% ）, the brain-related morbidity was 8. 3% （ 114/ 1 371 ）, and the brain-related mortality was 2.0% （27/1 371 ）. The incidence of spontaneous rupture was 1.6% （22/1 371 ）, the incidence of intraparenchymal hemorrhage was 2. 1% （29/1 371 ）, and the incidence of ischemic stroke was 4. 2% （58/1 371 ）. The brain-related morbidity of giant aneurysms after procedure was higher than that of the small or large aneurysms （X2 = 40. 42, P 〈 0. 05 ）, and the mortality was higher than the small or large aneurysms （X2 = 15.32, P 〈 0. 05 ）. The incidence of ischemic stroke of posterior circulation aneurysms after procedure was higher than that of the anterior circulation aneurysms （X2 = 8.50, P 〈0. 05 ）. The publication bias of occlusion rate was detected with Begg rank correlation method. The adjusted value was P=0. 011. Conclusions Generally, the results of meta-analysis support the safety and feasibility of intracranial aneurysms treated with PED. PED has a higher rate of occlusion after procedure. The incidence of serious complications was low. However, giant imracranial aneurysms have higher brain-related morbidity and mortality. The oosterior circulation aneurysms have higher risk of ischemic stroke,