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Journal of Neurosurgical Sciences 2020 April;64(2):200-5

DOI: 10.23736/S0390-5616.18.04633-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Treatment of anterior cerebral artery and anterior communicating artery aneurysms with flow-diversion devices: a systematic review and meta-analysis

Thomas J. SORENSON 1, 2, Vitor MENDES PEREIRA 3, 4, Leonardo RANGEL CASTILLA 2, 5, Chris A. HILDITCH 3, Patrick J. NICHOLSON 3, Waleed BRINJIKJI 2, 5

1 School of Medicine, University of Minnesota, Minneapolis, MN, USA; 2 Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; 3 Department of Medical Imaging, University of Toronto, Toronto, ON, Canada; 4 Department of Neurologic Surgery, University of Toronto, Toronto, ON, Canada; 5 Department of Radiology, Mayo Clinic, Rochester, MN, USA; 6 Center for Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA



INTRODUCTION: To assess the early safety and efficacy of anterior cerebral artery (ACA) and anterior communicating artery (ACoA) aneurysm treatment with flow-diversion devices (FDDs), we performed a systematic review and meta-analysis for these aneurysms.
EVIDENCE ACQUISITION: A literature search was performed by a reference librarian, and, after screening, eight case series were included for meta-analysis. We estimated from each study the cumulative incidence (event rate) and 95% confidence interval (CI) for each outcome. Event rates were pooled in a meta-analysis across studies using the random-effects model; descriptive statistics were reported when relevant.
EVIDENCE SYNTHESIS: 129 ACA and ACoA aneurysms from 8 series were included. Technical success rate of 96% (95% CI: 0.93 to 1.00) and a technical complication rate was 3% (95% CI: 0.00 to 0.06). Perioperative rates of ischemic stroke, hemorrhagic stroke, morbidity, and mortality were 3% (95% CI: 0.00 to 0.06), 5% (95% CI: 0.01 to 0.08), 3% (95% CI: 0.00 to 0.06 and 2% (95% CI: 0.00 to 0.05), respectively. The rate of treatment-related, long-term neurological deficit was 4% (95% CI: 0.01 to 0.07). Complete occlusion rate at last radiological follow-up was 79% (95% CI: 0.68 to 0.91).
CONCLUSIONS: FDDs are an acceptable tool for the treatment of ACA and ACoA aneurysms with high rates of technical success and low rates of periprocedural morbidity and mortality. Comparative studies with longer-term follow-up are needed to clarify the role of these devices in the management of ACA and ACoA aneurysms in patients with challenging comorbidities.


KEY WORDS: Anterior cerebral artery; Intracranial aneurysm; Endovascular procedures

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