Mohamed Abdel-Tawab1, Ahmed K Abdeltawab2, Mohamed Abdelmonem2, Mahmoud A Moubark1, Mohamed Ah Taha3, Abdalla Morsy4, Ahmed Awad Bessar5,6, Mahmoud Ahmed Ebada5,7. 1. Department of Diagnostic and Interventional Radiology, Assiut University Hospitals, Assiut, Egypt. 2. Faculty of Medicine, Fayoum University, Fayoum, Egypt. 3. Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt. 4. Department of Neurosurgery, Assiut University Hospitals, Assiut, Egypt. 5. Faculty of Medicine, Zagazig University, Zagazig, Egypt. 6. Department of Diagnostic and Interventional Radiology, Zagazig University, Zagazig, Egypt. 7. Department of Radiology, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt.
Abstract
PURPOSE: We aimed to assess the efficacy and safety of flow-diverter stents (FDs) in the management of posterior circulation cerebral aneurysms and compare FD efficacy between anterior and posterior circulation aneurysms. METHODS: We searched the PubMed, Scopus, Cochrane, and Web of Science databases for relevant studies through March 2020. Studies assessing FDs for posterior circulation aneurysms that included ≥20 treated aneurysms were included. Moreover, the studies compared FD efficacy between anterior and posterior circulation aneurysms were included. Data regarding angiographic aneurysmal occlusion, procedural complications, mortality, and morbidity were extracted and pooled in a random-effects meta-analysis model. RESULTS: Fourteen studies with a total of 659 patients and 676 posterior circulation aneurysms were included. The pooled rate of aneurysmal occlusion at long-term angiographic follow-up was 78% [95% confidence interval (CI), 71-85]. The pooled rates of intraparenchymal hemorrhage, ischemia, and procedure-related mortality and neurological morbidity were 2%, 8%, 7%, and 6%, respectively. Complete occlusion occurred in 82.4% of the posterior circulation aneurysm subgroup and 77.5% of the anterior circulation aneurysm subgroup. The difference was not significant (relative risk 1.01; 95% CI, 0.86-1.19; p = 0.91). Regression analysis showed that elderly patients and females had higher morbidity. CONCLUSION: Posterior circulation aneurysms can be effectively treated with FDs with comparable occlusion rates to those in anterior circulation aneurysms. However, periprocedural complications are not negligible.
PURPOSE: We aimed to assess the efficacy and safety of flow-diverter stents (FDs) in the management of posterior circulation cerebral aneurysms and compare FD efficacy between anterior and posterior circulation aneurysms. METHODS: We searched the PubMed, Scopus, Cochrane, and Web of Science databases for relevant studies through March 2020. Studies assessing FDs for posterior circulation aneurysms that included ≥20 treated aneurysms were included. Moreover, the studies compared FD efficacy between anterior and posterior circulation aneurysms were included. Data regarding angiographic aneurysmal occlusion, procedural complications, mortality, and morbidity were extracted and pooled in a random-effects meta-analysis model. RESULTS: Fourteen studies with a total of 659 patients and 676 posterior circulation aneurysms were included. The pooled rate of aneurysmal occlusion at long-term angiographic follow-up was 78% [95% confidence interval (CI), 71-85]. The pooled rates of intraparenchymal hemorrhage, ischemia, and procedure-related mortality and neurological morbidity were 2%, 8%, 7%, and 6%, respectively. Complete occlusion occurred in 82.4% of the posterior circulation aneurysm subgroup and 77.5% of the anterior circulation aneurysm subgroup. The difference was not significant (relative risk 1.01; 95% CI, 0.86-1.19; p = 0.91). Regression analysis showed that elderly patients and females had higher morbidity. CONCLUSION: Posterior circulation aneurysms can be effectively treated with FDs with comparable occlusion rates to those in anterior circulation aneurysms. However, periprocedural complications are not negligible.
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