-
World Neurosurgery Oct 2018To clarify the safety and efficacy of flow diverter (FD) treatment for blood blister-like aneurysm (BBA) through a systematic review and literature analyzing... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To clarify the safety and efficacy of flow diverter (FD) treatment for blood blister-like aneurysm (BBA) through a systematic review and literature analyzing perioperative and long-term clinical and angiographic outcomes.
METHODS
We performed a comprehensive review of the current literature for studies with >2 patients related to FD treatment of BBAs published. A random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurologic outcome.
RESULTS
We included 15 noncomparative studies with a total of 165 target BBAs. Complete occlusion rates were 72% (95% confidence interval [CI], 0.59-0.85). Recurrence occurred in 13% (95% CI, 0.04-0.29) and rebleeding in 3% (95% CI, -0.02 to 0.07) of patients. Procedure-related morbidity and mortality were 26% (95% CI, 0.19-0.33) and 3% (95% CI, -0.01 to 0.07), respectively. The rate of long-term good outcomes was 83% (95% CI, 0.77-0.89). Subgroup analysis indicated that a single FD strategy for BBA seemed to have a higher rate of good outcomes compared with an overlapped FD strategy (89.9% vs. 61.9%; odds ratio, 1.42; 95% CI, 1.25-14.98, P = 0.02). Complete occlusion rate and procedure-related morbidity rate did not see any significant difference between these 2 strategies.
CONCLUSIONS
Our meta-analysis suggests that in selected cases, FD can be safe and effective. A single FD strategy may result in a higher rate of good outcomes compared with an overlapped FD strategy. Ultimately, treatment of BBA should be considered on a case-by-case basis to maximize patient benefits and limit the risk of perioperative complications.
Topics: Aneurysm, Ruptured; Embolization, Therapeutic; Endovascular Procedures; Humans; Intracranial Aneurysm; Retrospective Studies; Self Expandable Metallic Stents; Treatment Outcome
PubMed: 29944999
DOI: 10.1016/j.wneu.2018.06.123 -
Journal of Vascular Surgery Oct 2022Iliac branch devices (IBDs) have been used in the treatment of aortoiliac and isolated iliac artery aneurysms. The aim of this systematic review and meta-analysis was to... (Meta-Analysis)
Meta-Analysis Review
A systematic review and meta-analysis of the clinical effectiveness and safety of unilateral versus bilateral iliac branch devices for aortoiliac and iliac artery aneurysms.
OBJECTIVE
Iliac branch devices (IBDs) have been used in the treatment of aortoiliac and isolated iliac artery aneurysms. The aim of this systematic review and meta-analysis was to investigate the clinical effectiveness and safety of IBDs.
METHODS
A systematic review of the literature was conducted by identifying studies in the Medline, EMBASE, and Cochrane databases regarding the outcomes of IBDs in aortoiliac or isolated iliac artery aneurysms between May 2006 and December 2020. Individual studies were evaluated for the following major outcomes: technical success, 30-day mortality, primary patency, endoleak, reintervention, and rates of pelvic ischemia. Furthermore, subgroup meta-analyses were performed to compare the pelvic ischemic events in patients with bilateral IBDs, unilateral IBDs, and bilateral internal iliac artery (IIA) embolization/coverage.
RESULTS
Forty-five studies with a total of 2736 patients undergoing unilateral or bilateral IBDs met inclusion criteria and were included in the analysis. The pooled technical success rate of IBDs was 98.0% (confidence interval [CI]: 97.3%-98.7%). After IBD treatment, the 30-day mortality rate was 0.4% (CI: 0.07%-0.70%); 30-day patency was 98.4% (CI: 97.7%-99.0%); buttock claudication developed in 1.84% (CI: 1.26%-2.41%); and endoleak occurred in 11.9% (CI: 9.2%-14.7%) and reintervention in 7.6% (CI: 5.65%-9.58%). Furthermore, in patients with bilateral iliac artery involvement, the pooled estimate rates of buttock claudication were 0.7% in the bilateral IBD group, 7.9% in unilateral IBD with contralateral IIA embolization patients, and 33.8% in bilateral IIA embolization/coverage patients, which were statistically significant among the three groups. Sexual dysfunction was 5.0% in the bilateral IIA occlusion group, which was significantly higher than that in IBD groups.
CONCLUSIONS
The utilization of IBDs in the treatment of aortoiliac or isolated iliac artery aneurysms is associated with high technical success rates as well as low incidences of pelvic ischemia. The risk of postoperative buttock claudication can be further decreased with both IIA preservation if patients are anatomically suitable for bilateral IBDs.
Topics: Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endoleak; Endovascular Procedures; Humans; Iliac Aneurysm; Iliac Artery; Intermittent Claudication; Ischemia; Prosthesis Design; Stents; Treatment Outcome
PubMed: 35314303
DOI: 10.1016/j.jvs.2022.03.005 -
Journal of Neurointerventional Surgery Apr 2022The Woven EndoBridge (WEB) device is a barrel-shaped nitinol mesh deployed within the aneurysmal sac. The absence of metallic mesh in the aneurysm's parent vessel lumen... (Review)
Review
The Woven EndoBridge (WEB) device is a barrel-shaped nitinol mesh deployed within the aneurysmal sac. The absence of metallic mesh in the aneurysm's parent vessel lumen obviates the need for potent antiplatelet therapy, making this device appealing for acutely ruptured aneurysms not amenable to clipping or coiling. To assess the literature regarding WEB treatment of these aneurysms, we performed a comprehensive systematic search of PubMed, MEDLINE, and EMBASE databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Keywords were combined with Boolean operators to increase search sensitivity and specificity ('woven endobridge device' AND 'ruptured'). Nine studies comprising 377 acutely ruptured aneurysms were included. Overall, 82.7% were wide-necked, 85.9% were located in the anterior circulation, and 26.9% of patients presented with poor subarachnoid hemorrhage grade. Intraprocedure and postprocedure complications occurred in 8.4% (95% CI 3.6% to 13.3%) and 1% (95% CI 0% to 2%), respectively. The post-treatment rebleeding rate was 0%. Rates of adequate occlusion (complete occlusion to neck remnant) and retreatment at last follow-up were 84.8% (95% CI 73% to 96.6%) and 4.5% (95% CI 2.2% to 6.8%), respectively. The favorable outcome rate (modified Rankin Scale score 0-2) was 62.2% (95% CI 53% to 71.4%); mortality was 13.6% (95% CI 9.7% to 17.6%). WEB treatment of acutely ruptured aneurysms results in high adequate occlusion rates, low perioperative complication rates, no rebleeding, and low recurrence requiring retreatment. This device is promising for acutely ruptured aneurysms not amenable to clipping or coiling, considering the lower need for antiplatelet regimens during the procedure or follow-up.
Topics: Aneurysm, Ruptured; Embolization, Therapeutic; Endovascular Procedures; Humans; Intracranial Aneurysm; Retrospective Studies; Treatment Outcome
PubMed: 34266907
DOI: 10.1136/neurintsurg-2021-017613 -
Cardiovascular and Interventional... Oct 2014This study was designed to undertake systematic review and meta-analysis of published comparative trials comparing embolic agents used in uterine artery embolisation... (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
This study was designed to undertake systematic review and meta-analysis of published comparative trials comparing embolic agents used in uterine artery embolisation (UAE) for uterine leiomyomata.
METHODS
Systematic literature searches were performed in MEDLINE, Embase, PubMed, and Cochrane Central databases from database inception to July 2012. Randomised and nonrandomised trials comparing two or more embolic agents used in UAE were included. Assessment included five widely used embolic agents: nonspherical polyvinyl alcohol (PVA) (Contour PVA, Boston Scientific or PVA Cook Medical); spherical PVA (Contour SE, Boston Scientific); acrylamido PVA (Beadblock, Biocompatibles, Terumo); tris-acryl gelatin microspheres (TAGM) (Embospheres, Merit Medical Inc); and polyzene-F hydrogel microspheres (Embozenes, CeloNova Biosciences). Outcomes assessed included: quality of life (QOL), assessment, magnetic resonance imaging (MRI), uterine and fibroid volumes and degrees of MRI fibroid enhancement and devascularisation. A total of 262 citations were reviewed with 5 randomised, controlled trials involving 295 women and 5 non-RCTs involving 617 women included.
RESULTS
No evidence of superiority of any embolic agent was demonstrated. Meta-analysis was performed between TAGM (Embospheres) and spherical PVA microspheres. Two RCTs found a trend toward greater uterine and dominant fibroid volume reductions with Embospheres but the combined differences were not statistically significant (p = 0.78 and p = 0.94 respectively). Embospheres demonstrated greater percentage fibroid devascularisation than spherical PVA (p = 0.039).
CONCLUSIONS
This study confirms that the current evidence demonstrates superiority of Embospheres over spherical PVA but no reported differences in outcomes between any of the other agents. Comparison of embolic agents was limited by lack of RCT data and further research is warranted.
Topics: Acrylic Resins; Female; Gelatin; Humans; Leiomyoma; Microspheres; Polyvinyl Alcohol; Treatment Outcome; Uterine Artery Embolization; Uterine Neoplasms
PubMed: 24305981
DOI: 10.1007/s00270-013-0790-0 -
American Journal of Cardiovascular... 2023The first-generation Watchman 2.5 (W 2.5) presented several limitations, such as challenges in implantation within complex left atrial appendage (LAA) anatomies, higher... (Review)
Review
INTRODUCTION
The first-generation Watchman 2.5 (W 2.5) presented several limitations, such as challenges in implantation within complex left atrial appendage (LAA) anatomies, higher incidence of peri-device leak, device recapture, and device-related thrombus (DRT). The newer generation Watchman FLX (W-FLX) was introduced with a modified design aiming to overcome these limitations. The purpose of this meta-analysis is to conduct a comparative assessment of the safety and efficacy of the W-FLX and 2.5 devices in clinical practice.
METHOD
The meta-analysis was conducted according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA). Studies were located through a search strategy utilizing PubMed, Cochrane, Google scholar and MEDLINE from inception to March 2023, with a primary objective to compare the safety and efficacy of the W-FLX and W 2.5 devices. After applying the selection criteria, five studies were included in this analysis.
RESULTS
The analysis included five studies comprising 54,727 patients. The W-FLX is associated with an increase in procedural success (OR 7.49 [95% CI 1.98-28.26, P = 0.02; = 0%]), and a significant reduction in mortality (OR 0.52 [95% CI 0.51-0.54, P<0.01; = 0%], major bleeding 0.57 [95% CI 0.51-0.64, P<0.01; = 0%]), device embolism (OR 0.35 [95% CI 0.18-0.70, P = 0.02; = 0%]), and pericardial effusion (OR 0.33 [95% CI 0.26-0.41, P<0.01; = 0%]). The rates of DRT and stroke were similar between the two groups.
CONCLUSION
Compared to the W 2.5, the W-FLX was associated with a higher procedural success rate and significantly reduced adverse outcomes including mortality, major bleeding, device embolization, and pericardial effusion.
PubMed: 38026111
DOI: No ID Found -
Cardiovascular Revascularization... Apr 2022To assess the safety and efficacy of the Amplatzer Septal Occluder in the closure of secundum type atrial septal defects. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To assess the safety and efficacy of the Amplatzer Septal Occluder in the closure of secundum type atrial septal defects.
BACKGROUND
The Amplatzer Septal Occluder (ASO; Abbott, St. Paul, MN) is an FDA-approved device for percutaneous closure of secundum type atrial septal defects (ASD). Previous small cohort trials have shown a favorable safety and technical efficacy profile.
METHODS
We conducted a systemic review and meta-analysis of all prospective case series and controlled trials that evaluated the ASO's safety and implant efficacy. The primary endpoint was the technical success rate of implantations. Secondary outcomes included proportions of arrhythmias and embolism specific-adverse events.
RESULTS
We included a total of 12 studies with 2972 patients. The ratio of device implantation was 2:1 by sex [female: male]. Pooled technical success rate of implantation was 98% (95% CI: 0.968-0.990, P < 0.01). The cumulative adverse event rate was 5.1% (95% CI: 0.035-0.068, P < 0.01), which included arrhythmia and embolism specific adverse event rates of 1.8% (95% CI: 0.007-0.032, P < 0.01) and 0.7% (95% CI: 0.002-0.013, P < 0.01), respectively. Sensitivity analysis did not significantly affect pooled outcomes for success rate and adverse events; both forest plot and Begg's and Egger's regression tests supported symmetricity.
CONCLUSION
A high likelihood of technical success can be expected when implanting the ASO in secundum type ASDs. Adverse event rates are expected for one in twenty patients, and thus, our results support the safe use of ASO in secundum type ASDs closure.
CONDENSED ABSTRACT
The AMPLATZER Septal Occluder is an FDA-approved device for percutaneous closure of secundum type atrial septal defects (ASD). We conducted a systemic review and meta-analysis of all prospective case series and controlled trials that evaluated the ASO's safety and implant efficacy. We included a total of 12 studies with 2972 patients. Pooled technical success rate of implantation was 98% (P < 0.01). The cumulative adverse event rate was 5.1% (P < 0.01), 1.8% (P < 0.01) rate of arrhythmias, and 0.7% (P < 0.01) rate of embolisms. A high likelihood of technical success can be expected with a low rate of adverse events.
Topics: Cardiac Catheterization; Cohort Studies; Female; Heart Septal Defects, Atrial; Humans; Male; Septal Occluder Device; Treatment Outcome
PubMed: 34183276
DOI: 10.1016/j.carrev.2021.06.002 -
World Neurosurgery Jul 2018The PulseRider is an innovative stent-like device designed for the treatment of intracranial bifurcation aneurysms. The aim of this study was to assess the current... (Review)
Review
BACKGROUND
The PulseRider is an innovative stent-like device designed for the treatment of intracranial bifurcation aneurysms. The aim of this study was to assess the current evidence on safety and effectiveness of the PulseRider.
METHODS
A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following databases were searched: PubMed, Ovid MEDLINE, and Scopus. The search strategy consisted of "pulserider," "bifurcation aneurysm," and "endovascular" in both AND and OR combinations. Studies included were original research articles in peer-reviewed journals. The manuscripts were thoroughly examined for study design, outcomes, and results.
RESULTS
Three studies were identified describing use of the PulseRider device in the treatment of 63 patients with 63 bifurcation aneurysms. We identified 2 multicenter case series and 1 single-arm clinical trial. The majority of aneurysms treated were located at the basilar tip (37, 58.7%). All devices were successfully deployed, and there were 5 intraoperative complications (7.9%), including 2 intraoperative aneurysm ruptures, 1 vessel dissection, and 2 thrombus formations. Immediate complete aneurysm occlusion was achieved in 61.9% (39/63) of cases and at the 6-month imaging follow-up, 66.7% (42/63) achieved complete aneurysm occlusion. One recanalization was reported in 1 of the multicenter case series within the 6-month follow-up.
CONCLUSIONS
The PulseRider is safe and probably effective for the treatment of intracranial bifurcation aneurysms, sometimes not amenable for stent-assisted coiling. However, current evidence is limited to a small sample and short follow-up. In addition, the device has not been compared with other treatment modalities.
Topics: Clinical Trials as Topic; Endovascular Procedures; Humans; Intracranial Aneurysm; Self Expandable Metallic Stents; Treatment Outcome
PubMed: 29698797
DOI: 10.1016/j.wneu.2018.04.102 -
International Braz J Urol : Official... 2023To review and compare the effectivity of novel minimally invasive treatments (MITs) to transurethral resection of the prostate (TURP) for the treatment of lower urinary... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To review and compare the effectivity of novel minimally invasive treatments (MITs) to transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) in men.
METHODS
Medline, Embase, and Cochrane databases were searched from January 2010 to December 2022 for randomized controlled trials (RCTs) evaluating MITs, compared to TURP or sham, in men with LUTS. Studies were assessed by risk of bias tool, and evidence by GRADE. Functional outcomes by means of uroflowmetry and IPSS were the primary outcomes, safety and sexual function were secondary outcomes. As part of this review, a network meta-analysis (NMA) was conducted. MITs were ranked based on functional outcome improvement probability.
RESULTS
In total, 10 RCTs were included, evaluating aquablation, prostatic urethral lift, prostatic artery embolization (PAE), convective water vapor thermal treatment or temporary implantable nitinol device. All MITs showed a better safety profile compared to TURP. Functional outcome improvement following aquablation were comparable to TURP. In the NMA, aquablation was ranked highest, PAE followed with the second highest probability to improve functional outcomes. Other novel MITs resulted in worse functional outcomes compared to TURP. Level of evidence was low to very low.
CONCLUSIONS
Five MITs for treatment of LUTS were identified. Aquablation is likely to result in functional outcomes most comparable to TURP. Second in ranking was PAE, a technique that does not require general or spinal anesthesia. MITs have a better safety profile compared to TURP. However, due to high study heterogeneity, results should be interpreted with caution.
Topics: Male; Humans; Prostatic Hyperplasia; Network Meta-Analysis; Treatment Outcome; Prostate; Transurethral Resection of Prostate; Lower Urinary Tract Symptoms
PubMed: 37267609
DOI: 10.1590/S1677-5538.IBJU.2023.0016 -
AJNR. American Journal of Neuroradiology Dec 2014Recent techniques of endoluminal reconstruction with flow-diverting stents have not been incorporated into treatment algorithms for cavernous carotid aneurysms. This... (Review)
Review
BACKGROUND AND PURPOSE
Recent techniques of endoluminal reconstruction with flow-diverting stents have not been incorporated into treatment algorithms for cavernous carotid aneurysms. This study examines the authors' institutional experience and a systematic review of the literature for outcomes and complications using the Pipeline Embolization Device in unruptured cavernous carotid aneurysms.
MATERIALS AND METHODS
A retrospective search for cavernous carotid aneurysms from a prospectively collected data base of aneurysms treated with the Pipeline Embolization Device at our institution was performed. Baseline demographic, clinical, and laboratory values; intrainterventional data; and data at all follow-up visits were collected. A systematic review of the literature for complication data was performed with inquiries sent when clarification of data was needed.
RESULTS
Forty-three cavernous carotid aneurysms were included in the study. Our mean radiographic follow-up was 2.05 years. On last follow-up, 88.4% of the aneurysms treated had complete or near-complete occlusion. Aneurysm complete or near-complete occlusion rates at 6 months, 12 months, and 36 months were 81.4%, 89.7%, and 100%, respectively. Of patients with neuro-ophthalmologic deficits on presentation, 84.2% had improvement in their visual symptoms. Overall, we had a 0% mortality rate and a 2.3% major neurologic complication rate. Our systematic review of the literature yielded 227 cavernous carotid aneurysms treated with the Pipeline Embolization Device with mortality and morbidity rates of 0.4% and 3.1%, respectively.
CONCLUSIONS
Endoluminal reconstruction with flow diversion for large unruptured cavernous carotid aneurysms can yield high efficacy with low complications. Further long-term data will be helpful in assessing the durability of the cure; however, we advocate a revisiting of current management paradigms for cavernous carotid aneurysms.
Topics: Adult; Aged; Angiography; Carotid Artery Diseases; Carotid Artery, Internal; Embolization, Therapeutic; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Retrospective Studies
PubMed: 25147199
DOI: 10.3174/ajnr.A4081 -
AJNR. American Journal of Neuroradiology Sep 2016We present the results of a systematic review and meta-analysis examining outcomes of endovascular coiling of wide-neck and wide-neck bifurcation aneurysms with and... (Review)
Review
BACKGROUND AND PURPOSE
We present the results of a systematic review and meta-analysis examining outcomes of endovascular coiling of wide-neck and wide-neck bifurcation aneurysms with and without stent assistance. The aim of our study was to assess angiographic and clinical outcomes.
MATERIALS AND METHODS
We performed a comprehensive literature search for all articles on the endovascular coiling of wide-neck and wide-neck bifurcation aneurysms. Studies meeting our inclusion criteria and abstracted data were selected by 2 independent reviewers. Primary outcomes were >6-month complete or near-complete angiographic occlusion, aneurysm recanalization, and aneurysm retreatment. Secondary outcomes included initial complete or near-complete occlusion, long-term good neurologic outcome, procedure-related morbidity, and procedure-related mortality. Data were analyzed by using random-effects meta-analysis.
RESULTS
In total, 38 studies including 2446 patients with 2556 aneurysms were included. For all wide-neck aneurysms, immediate complete or near-complete occlusion rate was 57.4% (95% CI, 48.1%-66.8%). Follow-up near-complete occlusion rate was 74.5% (95% CI, 68.0%-81.0%). Recanalization and retreatment rates were 9.4% (95% CI, 7.1%-11.7%) and 5.8% (95% CI, 4.1%-7.5%), respectively. Long-term good neurologic outcome was 91.4% (95% CI, 88.5%-94.2%). For wide-neck bifurcation aneurysms, initial complete or near-complete occlusion rate was 60.0% (95% CI, 42.7%-77.3%), long-term complete or near-complete occlusion rate was 71.9% (95% CI, 52.6%-91.1%), and the recanalization and retreatment rates were 9.8% (95% CI, 7.1%-12.5%) and 5.2% (95% CI, 1.9%-8.4%), respectively.
CONCLUSIONS
Our study of angiographic and clinical outcomes for patients with wide-neck aneurysms demonstrates that endovascular coiling with or without stent-assisted coiling is safe, with low rates of perioperative morbidity and mortality. Initial and long-term angiographic outcomes were generally satisfactory, but not ideal. These data provide some baseline comparisons against which emergent technologies can be assessed.
Topics: Adult; Aged, 80 and over; Diffusion Magnetic Resonance Imaging; Embolization, Therapeutic; Endovascular Procedures; Humans; Intracranial Aneurysm; Intracranial Embolism; Magnetic Resonance Imaging; Male; Metals; Middle Aged; Retrospective Studies; Stents; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 27256850
DOI: 10.3174/ajnr.A4834