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AJNR. American Journal of Neuroradiology Mar 2023Middle meningeal artery embolization is an emerging treatment option for chronic subdural hematomas. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Middle meningeal artery embolization is an emerging treatment option for chronic subdural hematomas.
PURPOSE
Our aim was to assess outcomes following middle meningeal artery embolization by different techniques, including in comparison with traditional surgical methods.
DATA SOURCES
We searched the literature databases from inception to March 2022.
DATA SELECTION
We selected studies reporting outcomes after middle meningeal artery embolization as a primary or adjunctive treatment for chronic subdural hematoma.
DATA ANALYSIS
We analyzed the risk of recurrence of chronic subdural hematoma, reoperation for recurrence or residual hematoma, complications, and radiologic and clinical outcomes using random effects modeling. Additional analyses were performed on the basis of whether middle meningeal artery embolization was used as the primary or adjunct treatment and by embolic agent type.
DATA SYNTHESIS
Twenty-two studies were included with 382 patients with middle meningeal artery embolization and 1373 surgical patients. The rate of subdural hematoma recurrence was 4.1%. Fifty (4.2%) patients underwent a reoperation for a recurrent or residual subdural hematoma. Thirty-six (2.6%) experienced postoperative complications. The rates of good radiologic and clinical outcomes were 83.1% and 73.3%, respectively. Middle meningeal artery embolization was significantly associated with decreased odds of subdural hematoma reoperation (OR = 0.48; 95% CI, 23.4-99.1; = .047) compared with surgery. The lowest rates of subdural hematoma radiologic recurrence, reoperation, and complications were observed among patients receiving embolization with Onyx, whereas good overall clinical outcome occurred most commonly with combined polyvinyl alcohol and coils.
LIMITATIONS
A limitation was the retrospective design of studies included.
CONCLUSIONS
Middle meningeal artery embolization is safe and effective, either as a primary or adjunctive treatment. Treatment using Onyx seems to yield lower rates of recurrence, rescue operation, and complications whereas particles and coils produce good overall clinical outcomes.
Topics: Humans; Hematoma, Subdural, Chronic; Meningeal Arteries; Retrospective Studies; Embolization, Therapeutic; Reoperation
PubMed: 36797028
DOI: 10.3174/ajnr.A7796 -
Arthritis and Rheumatism Jul 2011Systemic sclerosis (SSc) is characterized by calcification, vasculopathy, and endothelial wall damage, all of which can increase the risk of developing atherosclerosis... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Systemic sclerosis (SSc) is characterized by calcification, vasculopathy, and endothelial wall damage, all of which can increase the risk of developing atherosclerosis and cardiovascular disease. The aim of this study was to perform a systematic review and meta-analysis to determine whether the risk of atherosclerosis is increased in SSc patients compared to healthy individuals.
METHODS
A systematic search was performed to identify studies published in PubMed and the Cochrane database up to May 2010, and recently published abstracts were also reviewed. Two reviewers independently screened articles to identify studies comparing the rate of atherosclerosis in SSc patients to that in healthy controls. The studies utilized one of the following methods: angiography, Doppler ultrasound to assess plaque and carotid intima-media thickness (IMT), computed tomography, magnetic resonance imaging, flow-mediated vasodilation (assessed as the FMD%), the ankle-brachial index, or autopsy. For carotid IMT and FMD% values, we computed a pooled estimate of the summary mean difference and explored predictors of carotid IMT using random-effects meta-regression.
RESULTS
Of the 3,156 articles initially identified, 31 were selected for systematic review. The meta-analysis included 14 studies assessing carotid IMT and 7 assessing brachial artery FMD%. Compared to healthy controls, SSc patients had a higher prevalence of coronary atherosclerosis, peripheral vascular disease, and cerebrovascular calcification. Meta-analysis showed that SSc patients had increased carotid IMT (summary mean difference 0.11 mm, 95% confidence interval [95% CI] 0.05 mm, 0.17 mm; P = 0.0006) and lower FMD% (summary mean difference -3.07%, 95% CI -5.44%, -0.69%; P = 0.01) compared to controls. There was marked heterogeneity between the studies, which was mainly attributable to variations in disease duration and differences in the mean/median age between SSc patients and controls.
CONCLUSION
Patients with SSc have an increased risk of atherosclerosis compared to healthy subjects. Further studies should elucidate the mechanism of this increased risk.
Topics: Atherosclerosis; Brachial Artery; Carotid Arteries; Humans; Risk; Scleroderma, Systemic; Tunica Intima; Tunica Media; Ultrasonography
PubMed: 21480189
DOI: 10.1002/art.30380 -
CMAJ : Canadian Medical Association... Mar 2008Alterations in waveforms in the uterine artery are associated with the development of pre-eclampsia and intrauterine growth restriction. We investigated the predictive... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Alterations in waveforms in the uterine artery are associated with the development of pre-eclampsia and intrauterine growth restriction. We investigated the predictive accuracy of all uterine artery Doppler indices for both conditions in the first and second trimesters.
METHODS
We identified relevant studies through searches of MEDLINE, EMBASE, the Cochrane Library and Medion databases (all records to April 2006) and by checking bibliographies of identified studies and consulting with experts. Four of us independently selected studies, extracted data and assessed study validity. We performed a bivariable meta-analysis of sensitivity and specificity and calculated likelihood ratios.
RESULTS
We identified 74 studies of pre-eclampsia (total 79,547 patients) and 61 studies of intrauterine growth restriction (total 41 131 patients). Uterine artery Doppler ultrasonography provided a more accurate prediction when performed in the second trimester than in the first-trimester. Most Doppler indices had poor predictive characteristics, but this varied with patient risk and outcome severity. An increased pulsatility index with notching was the best predictor of pre-eclampsia (positive likelihood ratio 21.0 among high-risk patients and 7.5 among low-risk patients). It was also the best predictor of overall (positive likelihood ratio 9.1) and severe (positive likelihood ratio 14.6) intrauterine growth restriction among low-risk patients.
INTERPRETATION
Abnormal uterine artery waveforms are a better predictor of pre-eclampsia than of intrauterine growth restriction. A pulsatility index, alone or combined with notching, is the most predictive Doppler index. These indices should be used in clinical practice. Future research should also concentrate on combining uterine artery Doppler ultrasonography with other tests.
Topics: Adult; Arteries; Confidence Intervals; Female; Fetal Growth Retardation; Humans; Incidence; Placental Circulation; Pre-Eclampsia; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pulsatile Flow; Risk Assessment; Sensitivity and Specificity; Ultrasonography, Doppler; Ultrasonography, Prenatal; Uterus
PubMed: 18332385
DOI: 10.1503/cmaj.070430 -
Polski Przeglad Chirurgiczny Aug 2022<b>Introduction:</b> The anatomical location of the popliteal artery is one of the greatest challenges for percutaneous interventions. The biomechanical...
<b>Introduction:</b> The anatomical location of the popliteal artery is one of the greatest challenges for percutaneous interventions. The biomechanical attributes of the vessel lead to higher rates of restenosis, stent fracture, and occlusion. Some surgeons consider the popliteal artery as a no stenting zone. Many specialists favor percutaneous transluminal angioplasty to be the first line of endovascular treatment in the popliteal artery with bail-out stent implantation if the results are suboptimal. The Supera peripheral stent system is a novel stent that has been manufactured with a high degree of flexibility and supposedly might be appropriate for implantation in the popliteal artery. </br></br> <b>Aim:</b> Evaluation of the performance of Supera stent in isolated popliteal artery disease in comparison to other methods of treatment. </br></br> <b>Methods:</b> As many as 92 articles were found in the databases and after full-text review, 4 studies matched the inclusion criteria and were evaluated. </br></br> <b>Results:</b> Primary patency rates of Supera implantation in an isolated popliteal artery at 12 months ranged from 68% to 90%. In all four studies, no stent fractures were observed. Only one study provided longer follow-up than 12 months and evaluated the performance of the Supera stent 36 months after implantation. </br></br> <b>Conclusion:</b> In conclusion, mentioned studies show promising and superior to other stent patency rates of the Supera stent regarding popliteal artery lesions. What is more, no stent fracture is promising regarding longer follow-up. However, more studies with longer follow-ups and direct comparison to other methods are required to fully evaluate Supera's performance in the popliteal artery.
Topics: Humans; Femoral Artery; Peripheral Arterial Disease; Popliteal Artery; Risk Factors; Stents; Treatment Outcome; Vascular Patency
PubMed: 36807095
DOI: 10.5604/01.3001.0015.9578 -
BMC Ophthalmology Dec 2016Colour Doppler analysis of ophthalmic vessels has been proposed as a promising tool in the diagnosis of various eye diseases, but the available diagnostic evidence has... (Review)
Review
Colour Doppler analysis of ophthalmic vessels in the diagnosis of carotic artery and retinal vein occlusion, diabetic retinopathy and glaucoma: systematic review of test accuracy studies.
BACKGROUND
Colour Doppler analysis of ophthalmic vessels has been proposed as a promising tool in the diagnosis of various eye diseases, but the available diagnostic evidence has not yet been assessed systematically. We performed a comprehensive systematic review of the literature on the diagnostic properties of Colour Doppler imaging (CDI) assessing ophthalmic vessels and provide an inventory of the available evidence.
METHODS
Eligible papers were searched electronically in (Pre) Medline, Embase and Scopus, and via cross-checking of reference lists. The minimum requirement to be included was the availability of original data and the possibility to construct a two-by-two table. Study selection, critical appraisal using the QUADAS II instrument and extraction of salient study characteristics was made in duplicate. Sensitivity and specificity was computed for each study.
RESULTS
We included 11 studies (15 two-by-two tables) of moderate methodological quality enrolling 820 participants (range 30 to 118). In 44.4% participants were female (range 37-59% in specific subgroups). CDI was assessed for internal carotid stenosis, diabetic retinopathy, glaucoma, and branch or central retinal vein occlusion diagnosis. There was insufficient data to pool the results for specific illnesses. For the assessments of ophthalmic arteries, mean sensitivity was 0.69 (range 0.27-0.96) with a corresponding mean specificity of 0.83 (range 0.70-0.96). Mean sensitivity of the central retinal artery assessments was 0.58 (range 0.31-0.84) and the corresponding mean specificity was 0.82 (range 0.63-0.94).
CONCLUSIONS
Robust assessments of the diagnostic value of colour Doppler analysis remain uncommon, limiting the possibilities to extrapolate its true potential for clinical practice. PROSPERO 2014:CRD42014014027.
Topics: Carotid Artery Diseases; Diabetic Retinopathy; Glaucoma; Humans; Ophthalmic Artery; Regional Blood Flow; Retinal Artery; Retinal Vein Occlusion; Sensitivity and Specificity; Ultrasonography, Doppler, Color
PubMed: 27927176
DOI: 10.1186/s12886-016-0384-0 -
Health Technology Assessment... 2000Coronary artery stents are prosthetic linings inserted into coronary arteries via a catheter to widen the artery and increase blood flow to ischaemic heart muscle. They... (Review)
Review
BACKGROUND
Coronary artery stents are prosthetic linings inserted into coronary arteries via a catheter to widen the artery and increase blood flow to ischaemic heart muscle. They are used in the treatment of ischaemic heart disease (IHD). IHD is a major cause of morbidity and mortality (123,000 deaths per annum) in the UK and a major cost to the NHS. Clinical effects of IHD include subacute manifestations (stable and unstable angina) and acute manifestations (particularly myocardial infarction [MI]). Treatment includes attention to risk factors, drug therapy, percutaneous invasive interventions (PCIs) (including percutaneous transluminal coronary angioplasty [PTCA] and stents) and coronary artery bypass graft surgery (CABG). In the last decade there has been a steady and significant increase in the rate of PCIs for IHD. In the UK, rates per million population increased from 174 in 1991 to 437 in 1998. Stents are now used in about 70% of PCIs. Data from the rest of Europe suggest there is potential for PCI and stent rates to increase considerably. In the UK there is evidence of under-provision and inequity of access to revascularisation procedures.
OBJECTIVES
The following questions were addressed. 1. What are the effects and effectiveness of elective stent insertion versus PTCA in subacute IHD, particularly stable angina and unstable angina? 2. What are the effects and effectiveness of elective stent insertion versus CABG in subacute IHD, particularly stable angina and unstable angina? 3. What are the effects and effectiveness of elective stent insertion versus PTCA in acute MI (AMI)? 4. What are best estimates of UK cost for elective stent insertion, PTCA and CABG in the circumstances of review questions 1 to 3? 5. What are best estimates of cost-effectiveness and cost-utility for elective stent insertion relative to PTCA or CABG in the circumstances of review questions 1 to 3?
METHODS
A systematic review addressing the objectives was undertaken.
DATA SOURCES
A search was made for RCTs comparing stents (inserted during a PTCA procedure) with PTCA alone or with CABG in any manifestation of IHD. The search strategy covered the period from 1990 to November 1999 and included searches of electronic databases (MEDLINE, EMBASE, BIDS ISI, The Cochrane Library), Internet sites, and hand-searches of cardiology conference abstracts and 1999 issues of cardiology journals. Lead researchers and local clinical experts were contacted. Manufacturers' submissions to the National Institute for Clinical Excellence were searched. The search strategy was expanded to look for relevant economic analyses and information to inform the economic model (including searching MEDLINE, the NHS Economic Evaluation Database and the Database of Abstracts of Reviews of Effectiveness). Searches focused on research that reported costs and quality of life data associated with IHD and interventional cardiology.
STUDY SELECTION
For the review of clinical effectiveness, inclusion criteria were: (i) RCT design; (ii) study population comprising adults with IHD in native or graft vessels (including patients with subacute IHD or AMI); (iii) procedure involving elective insertion of coronary artery stents; (iv) elective PTCA (including PTCA with provisional stenting) or CABG as comparator; (v) outcomes defined as one or more of: combined event rate (or event-free survival), death, MI, angina, target vessel revascularisation, CABG, repeat PTCA, angiographic outcomes; (vi) trials that had closed and reported results for all or almost all recruited patients. For the economic evaluation, studies of adults with IHD were included if they were of the following types: studies reporting UK costs; comparative economic evaluation combining both costs and outcomes; economic evaluations reporting costs and outcomes separately for the years 1998 and 1999 (to ensure current practice was included).(ABSTRACT TRUNCATED)
Topics: Adult; Angina Pectoris; Angioplasty, Balloon, Coronary; Coronary Artery Bypass; Coronary Vessels; Cost-Benefit Analysis; Humans; Myocardial Infarction; Myocardial Ischemia; Stents; Technology Assessment, Biomedical; United Kingdom
PubMed: 11074393
DOI: No ID Found -
HPB : the Official Journal of the... Jul 2013The management of hilar cholangiocarcinoma has evolved over time and extended liver resection, including the caudate lobe, and major vascular resection and extended... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The management of hilar cholangiocarcinoma has evolved over time and extended liver resection, including the caudate lobe, and major vascular resection and extended lymphadenectomy have become established practice. The benefit of vascular resection has not been investigated.
METHODS
A systematic search of the MEDLINE and EMBASE databases was used to identify studies. A systematic review and a meta-analysis of the available studies were conducted according to PRISMA guidelines. Odds ratios were calculated using the Mantel-Haenszel method. Primary outcome variables assessed included morbidity, mortality, vascular complications and the effect of vascular resection on longterm survival.
RESULTS
Of 411 search results, only 24 studies reported the results of vascular resection in hilar cholangiocarcinoma. Meta-analysis showed increased morbidity and mortality with hepatic artery resection. Portal vein resection was achievable with no impact on postoperative mortality. Vascular resection did not improve negative margin rates and had no impact on longterm survival.
CONCLUSIONS
Portal vein resection does not preclude curative resection; however, it is not routinely recommended unless there is suspicion of tumour invasion. There was no proven survival advantage with portal vein resection. Arterial resection results in higher morbidity and mortality with no proven benefit.
Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Chi-Square Distribution; Cholangiocarcinoma; Hepatectomy; Hepatic Artery; Humans; Lymph Node Excision; Neoplasm Invasiveness; Odds Ratio; Portal Vein; Risk Factors; Time Factors; Treatment Outcome; Vascular Surgical Procedures
PubMed: 23750491
DOI: 10.1111/j.1477-2574.2012.00616.x -
Ultrasound in Obstetrics & Gynecology :... Aug 2014First, to estimate the prevalence of fetal aberrant right subclavian artery (ARSA) in our population and its association with Down syndrome. Second, to determine the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
First, to estimate the prevalence of fetal aberrant right subclavian artery (ARSA) in our population and its association with Down syndrome. Second, to determine the feasibility of ultrasound to visualize ARSA in the three planes. Finally, to carry out a systematic review of the literature on the performance of second-trimester ARSA to identify fetuses with Down syndrome.
METHODS
ARSA was assessed by ultrasound in the axial plane and confirmed in the longitudinal and coronal planes during the second half of pregnancy in women attending our unit (from February 2011 to December 2012). A search of diagnostic tests for the assessment of ARSA was carried out in international databases. Relevant studies were subjected to a critical reading, and meta-analysis was performed with Meta-DiSc.
RESULTS
Of the 8781 fetuses in our population (mean gestational age: 24 ± 5.4 weeks), 22 had Down syndrome. ARSA was detected in the axial view in 60 cases (0.7%) and confirmed in the coronal view in 96.7% and in the longitudinal view in 6.7% (P < 0.001). Seven cases with ARSA had Down syndrome and all were in the non-isolated-ARSA group. The estimates of positive likelihood ratio (LR) were 0 for isolated ARSA and 199 (95% CI, 88.9-445.2) for non-isolated ARSA. In the systematic review, six studies were selected for quantitative synthesis. The pooled estimates of positive and negative LRs for global ARSA were, respectively, 35.3 (95% CI, 24.4-51.1) and 0.75 (95% CI, 0.64-0.87). For isolated ARSA, the positive and negative LRs were 0 (95% CI, 0.0-14.7) and 0.98 (95% CI, 0.94-1.02), respectively.
CONCLUSIONS
The prevalence of ARSA seems close to 1%. The coronal plane is the most suitable for its confirmation after detection in the axial plane. Detection of isolated or non-isolated ARSA should guide decisions about karyotyping given that isolated ARSA shows a weak association with Down syndrome.
Topics: Adult; Aneurysm; Cardiovascular Abnormalities; Chromosome Aberrations; Congenital Abnormalities; Deglutition Disorders; Down Syndrome; Echocardiography; Female; Fetus; Humans; Pregnancy; Pregnancy Trimester, Second; Subclavian Artery; Ultrasonography, Prenatal
PubMed: 24585513
DOI: 10.1002/uog.13336 -
BMJ Open Mar 2016Systematic review and meta-analysis on the diagnostic accuracy of temporal artery thermometers (TAT). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Systematic review and meta-analysis on the diagnostic accuracy of temporal artery thermometers (TAT).
DESIGN
Systematic review and meta-analysis. The index test consisted of temperature measurement with TAT. The reference test consisted of an estimation of core temperature.
PARTICIPANTS
Clinical patients as well as healthy participants, with or without fever.
INTERVENTIONS
Literature search in PubMed, Embase, Cinahl and Web of Science. Three reviewers selected articles for full-text reading after which a further selection was made. Risk of bias was assessed with QUADAS-2. Pooled difference and limits of agreement (LoA) were estimated with an inverse variance weighted approach. Subgroup and sensitivity analyses were performed. Sensitivity and specificity were estimated using hierarchical models. Quality of evidence was assessed according to the GRADE system.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome was measurement accuracy expressed as mean difference ± 95% LoA. A secondary outcome was sensitivity and specificity to detect fever. If tympanic thermometers were assessed in the same population as TAT, these results were recorded as well.
RESULTS
37 articles comprising 5026 participants were selected. Pooled difference was -0.19 °C (95% LoA -1.16 to 0.77 °C), with moderate quality of evidence. Pooled sensitivity was 0.72 (95% CI 0.61 to 0.81) with a specificity of 0.94 (95% CI 0.87 to 0.97). The subgroup analysis revealed a trend towards underestimation of the temperature for febrile patients. There was a large heterogeneity among included studies with wide LoA which reduced the quality of evidence.
CONCLUSIONS
TAT is not sufficiently accurate to replace one of the reference methods such as rectal, bladder or more invasive temperature measurement methods. The results are, however, similar to those with tympanic thermometers, both in our meta-analysis and when compared with others. Thus, it seems that TAT could replace tympanic thermometers with the caveat that both methods are inaccurate.
TRIAL REGISTRATION NUMBER
CRD42014008832.
Topics: Body Temperature; Fever; Healthy Volunteers; Humans; Sensitivity and Specificity; Temporal Arteries; Thermometers; Thermometry
PubMed: 27033957
DOI: 10.1136/bmjopen-2015-009509 -
Journal of Vascular Surgery Jun 2005Duplex ultrasound is widely used for the diagnosis of internal carotid artery stenosis. Standard duplex ultrasound criteria for the grading of internal carotid artery... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Duplex ultrasound is widely used for the diagnosis of internal carotid artery stenosis. Standard duplex ultrasound criteria for the grading of internal carotid artery stenosis do not exist; thus, we conducted a systematic review and meta-analysis of the relation between the degree of internal carotid artery stenosis by duplex ultrasound criteria and degree of stenosis by angiography.
METHODS
Data were gathered from Medline from January 1966 to January 2003, the Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, ACP Journal Club, UpToDate, reference lists, and authors' files. Inclusion criteria were the comparison of color duplex ultrasound results with angiography by the North American Symptomatic Carotid Endarterectomy Trial method; peer-reviewed publications, and >/=10 adults.
RESULTS
Variables extracted included internal carotid artery peak systolic velocity, internal carotid artery end diastolic velocity, internal carotid artery/common carotid artery peak systolic velocity ratio, sensitivity and specificity of duplex ultrasound scanning for internal carotid artery stenosis by angiography. The Standards for Reporting of Diagnostic Accuracy (STARD) criteria were used to assess study quality. Sensitivity and specificity for duplex ultrasound criteria were combined as weighted means by using a random effects model. The threshold of peak systolic velocity >/=130 cm/s is associated with sensitivity of 98% (95% confidence intervals [CI], 97% to 100%) and specificity of 88% (95% CI, 76% to 100%) in the identification of angiographic stenosis of >/=50%. For the diagnosis of angiographic stenosis of >/=70%, a peak systolic velocity >/=200 cm/s has a sensitivity of 90% (95% CI, 84% to 94%) and a specificity of 94% (95% CI, 88% to 97%). For each duplex ultrasound threshold, measurement properties vary widely between laboratories, and the magnitude of the variation is clinically important. The heterogeneity observed in the measurement properties of duplex ultrasound may be caused by differences in patients, study design, equipment, techniques or training.
CONCLUSIONS
Clinicians need to be aware of the limitations of duplex ultrasound scanning when making management decisions.
Topics: Blood Flow Velocity; Carotid Artery, Internal; Carotid Stenosis; Humans; Radiography; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Duplex
PubMed: 15944595
DOI: 10.1016/j.jvs.2005.02.044