Romain Touzé1,2, Bastien Gravellier3, Claudia Rolla-Bigliani1, Valérie Touitou2,4, Eimad Shotar1,4, Stéphanie Lenck1, Anne-Laure Boch5, Vincent Degos6,7, Nader-Antoine Sourour1, Frédéric Clarençon1,4. 1. Interventional Neuroradiology Unit, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France. 2. Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France. 3. Advanced Scientific Statistics Unit, University of Paris-Saclay, Paris, France. 4. Sorbonne University of Paris 6, Paris, France. 5. Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France. 6. Department of Anesthesiology, Pitié-Salpêtrère Hospital, Paris, France. 7. Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France.
Abstract
BACKGROUND: Flow-diverter stents (FDSs) have recently gained acceptance for the treatment of intracranial aneurysms, especially for carotid-ophthalmic aneurysms (COAs). However, complications have been reported after coverage of side branches, especially the ophthalmic artery (OA). OBJECTIVE: To evaluate, through a meta-analysis, the occlusion rate, and the ophthalmic complications after treatment of COA by FDS. METHODS: We reviewed on MEDLINE via PubMed, Embase via Ovid, and Cochrane central database via CENTRAL. We included all case series with at least 15 patients and clinical trials about flow diversion of aneurysms close to the OA's origin. Among these studies, we only included articles with aneurysm occlusion rate and rate of new ophthalmic symptoms. RESULTS: We included 16 studies with 913 COA treated by FDSs and covering the OA with a mean follow-up of 16.4 mo. The random-effect modeling analysis concerning the overall rate of new ophthalmic complications, after FDS deployment covering the OA, was 3.0% (CI95% 1.0-6.0). There was medium-high heterogeneity in the study reports P < .01, I2 = 70.2% [50.4%; 82.1%]. We were not able to statistically explain this heterogeneity with the performed analysis, which could be related to the design of the included studies. We found an overall aneurysm occlusion rate of 85.0% (95% CI 80.0-89.0). CONCLUSION: Our meta-analysis found a high aneurysm occlusion rate (85%) and low rate of iatrogenic visual complications, with only 3.0% of new visual symptoms, after treatment of COA by FDS.
BACKGROUND: Flow-diverter stents (FDSs) have recently gained acceptance for the treatment of intracranial aneurysms, especially for carotid-ophthalmic aneurysms (COAs). However, complications have been reported after coverage of side branches, especially the ophthalmic artery (OA). OBJECTIVE: To evaluate, through a meta-analysis, the occlusion rate, and the ophthalmic complications after treatment of COA by FDS. METHODS: We reviewed on MEDLINE via PubMed, Embase via Ovid, and Cochrane central database via CENTRAL. We included all case series with at least 15 patients and clinical trials about flow diversion of aneurysms close to the OA's origin. Among these studies, we only included articles with aneurysm occlusion rate and rate of new ophthalmic symptoms. RESULTS: We included 16 studies with 913 COA treated by FDSs and covering the OA with a mean follow-up of 16.4 mo. The random-effect modeling analysis concerning the overall rate of new ophthalmic complications, after FDS deployment covering the OA, was 3.0% (CI95% 1.0-6.0). There was medium-high heterogeneity in the study reports P < .01, I2 = 70.2% [50.4%; 82.1%]. We were not able to statistically explain this heterogeneity with the performed analysis, which could be related to the design of the included studies. We found an overall aneurysm occlusion rate of 85.0% (95% CI 80.0-89.0). CONCLUSION: Our meta-analysis found a high aneurysm occlusion rate (85%) and low rate of iatrogenic visual complications, with only 3.0% of new visual symptoms, after treatment of COA by FDS.