血流导向装置对颅内未破裂动脉瘤治疗效果的系统回顾及Meta分析

Systematic review and Meta-analysis of flow diverter for unruptured intracranial aneurysms

目的通过Meta分析方法对血流导向装置(flow diverter,FD)治疗颅内未破裂动脉瘤的治疗效果进行系统评价。方法在Pubmed、Web of Science、Google Scholar、中国知网(CNKI)和万方数据库中检索使用FD治疗颅内未破裂动脉瘤的相关文献,并按照特定的纳入和排除标准进行筛选。采用美国卫生保健质量和研究机构(agency for healthcare research and quality,AHRQ)对所选文献进行质量评价,提取所需原始数据,使用随机效应模型Meta分析计算术后6个月随访时的动脉瘤闭塞率、病残率和病死率。结果纳入10篇临床研究,总计548例病人共581个动脉瘤。在术后6个月影像学随访时,总的动脉瘤闭塞率为71%;既往接受过支架治疗后失败的动脉瘤,经FD二次治疗后6个月的闭塞率明显低于使用FD进行初次治疗的动脉瘤的闭塞率(P=0.03)。动脉瘤破裂的发生率为1%,脑实质出血(intraparenchymal hemorrhage,IPH)的发生率为1%,缺血性卒中的发生率为2%,总病死率为2%。结论 Meta分析结果显示FD治疗颅内动脉瘤疗效可靠,但与FD相关的致命性并发症不容忽视。既往接受支架治疗的复发动脉瘤,行FD二次治疗效果不佳。选择手术方式时应综合这些因素。

Objective To make a systematic evaluaion of the efficacy of flow diverter（FD） for unruptured intracranial aneurysms by Meta-analysis.Methods The related literatures about FD for unruptured intracranial aneurysms were searched in Pubmed,Web of Science,Google Scholar,CNKI and Wanfang database and screened according to the specific inclusion and exclusion criteria.The quality evaluation was made for chosen literatures by agency for healthcare research and quality（AHRQ） and the original data was extracted.The rates of occlusion,disability and mortality of aneurysms 6 months after surgery were counted by Meta analysis using random-effect model.Results Ten literatures of clinical research were analyzed in this study,including 548 patients with 581 aneurysms.The imaging follow-up results showed the total occlusion rate of aneurysms was 71% 6 months after surgery.The occlusion rate of the aneurysms which previously failed to be treated with stent was significantly lower 6 months after FD use than those using FD in the first time（P = 0.03）.The rates of aneurysm rupture,intraparenchymal hemorrhage and ischemic stroke were 1%,1% and 2%respectively.The total mortality was 2%.Conclusions The study showed that the FD is effective for intracranial aneurysms.However,the risks of fetal complications cannot be ignored.The recurrent aneurysm patients who were previously treated with stents would have a low occlusion rate after FD treatment.The factors influencing the treatment should be considered comprehensively when choosing the surgical procedures.