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How safe and effective are existing treatments for wide-necked bifurcation aneurysms? Literature-based objective performance criteria for safety and effectiveness.
- Source :
-
Journal of neurointerventional surgery [J Neurointerv Surg] 2017 Dec; Vol. 9 (12), pp. 1197-1201. Date of Electronic Publication: 2017 Aug 10. - Publication Year :
- 2017
-
Abstract
- Introduction: Wide-necked bifurcation aneurysms (WNBAs) present unique technical challenges for both endovascular and surgical treatments which aim to achieve complete occlusion of the aneurysm without compromising the patency of the incorporated regional parent vessels. We present a meta-analysis of traditional therapies for WNBAs to provide critical benchmarks for safety and effectiveness.<br />Methods: Following a systematic search of the literature and the application of pre-specified appropriateness criteria, 43 (including 2794 aneurysms treated) and 65 (including 5366 patients treated) references with sufficient detail were identified to include in a meta-analysis of efficacy and safety, respectively. Effectiveness endpoints of both complete and adequate occlusion were assessed. A composite safety endpoint was based upon commonly applied metrics for major adverse events. Fleiss analyses were performed for both effectiveness and safety endpoints for the entire group, and then parsed separately by treatment modality (surgical clipping (SC) or endovascular therapy (EVT)) and location (anterior or posterior circulation).<br />Results: Using the above methods, the core laboratory adjusted rate of complete occlusion was 46.3% (standard error 3.6%), 39.8% (3.7%), and 52.5% (9.6%) for all therapies, EVT, and SC, respectively. The rate of adequate occlusion was 59.4% (12.2%), 43.8% (5.3%), and 69.7% (14.3%) for all therapies, EVT, and SC, respectively. The rates of occurrence for pre-specified safety endpoints were 18.7% (2.9%), 21.1% (2.8%), and 24.3% (4.9%) for all therapies, EVT, and SC, respectively.<br />Conclusions: Conventional therapies for WNBAs are associated with relatively low rates of complete occlusion and peri-procedural complications are not uncommon. As new treatment technologies are investigated, it is important that the available data regarding predicate treatments is understood.<br />Competing Interests: Competing interests: The primary investigators received institutional salary support for the WEB-IT study, proctoring, consulting and study-related activities from Microvention Inc.<br /> (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
- Subjects :
- Aneurysm, Ruptured diagnostic imaging
Aneurysm, Ruptured therapy
Embolization, Therapeutic adverse effects
Endovascular Procedures adverse effects
Humans
Intracranial Aneurysm diagnostic imaging
Middle Aged
Treatment Outcome
Embolization, Therapeutic methods
Endovascular Procedures methods
Intracranial Aneurysm therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1759-8486
- Volume :
- 9
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Journal of neurointerventional surgery
- Publication Type :
- Academic Journal
- Accession number :
- 28798268
- Full Text :
- https://doi.org/10.1136/neurintsurg-2017-013223