-
7/23/2019 JR 2
1/18
Endovascular Treatment ofIntracranial Aneurysms in
Elderly Patients: A SystematicReview and Meta-Analysis
2ndJournal Reading
Saturday, 11 October 2014
Presenter : dr. Steviyani
Moderator : dr. Cairil !"in #atubara M$ed %&eu' S(.S
-
7/23/2019 JR 2
2/18
INTRODUCTION
Endovascular coiling alternative to surgicalclipping in elderly patients with aneurysmalsubarachnoid hemorrhage (!"# and unrupturedintracranial aneurysms (I!s#
everal studies have e$amined the ris%sassociated with endovascular treatment o&ruptured and unruptured I!s in elderly patients'but large series are relatively lac%ing
To understand sa&ety and ecacy pro)lesassociated with the endovascular treatment o& I!sin patients *+, years o& age' we per&ormed ameta-analysis o& the literature
-
7/23/2019 JR 2
3/18
.!TERI!/ !ND .ET"OD
Study selection
0ey words intracranial aneurysm' unrupturedaneurysm' berry aneurysm'cerebral aneurysm' !"'elderly' coiling' emboli1ation' age' endovascular'and older' to search 2ub.ed' Ovid .edline' OvidE.3!E' copus' and 4eb o& cience database
!ll studies reporting series o& elderly patientstreated with endovascular coiling &or I!s were
selected
-
7/23/2019 JR 2
4/18
tudy election
Inclusion criteria
English language
*+, years o& age
availability o& clinicaloutcome data(perioperative andpostoperative
complications'occlusion rates' andoutcome#
Exclusion criteria
studies with 5
678 patients
review articles9uidelines
technical notes
eries in which all
patients were selectedbecause o& having acertain ma:orcomplication;
-
7/23/2019 JR 2
5/18
-
7/23/2019 JR 2
6/18
Outcomes and Complications
aneurysm rupture status
aneurysm ad:unctive treatmenttechni
-
7/23/2019 JR 2
7/18
tatistical !nalysis
4e assessed the cumulative incidence(event rate# and =,> con)dence interval(CI# &or each outcome;
Cumulative outcomes(ruptured?unruptured# were alsocalculated &or all outcomes;
2erioperative complication rates andclinical outcomes were calculated
separately &or ruptured and unrupturedaneurysms
Event rates were pooled across studiesusing random e@ects meta-analysis
-
7/23/2019 JR 2
8/18
ubgroup interactions (analysis o&covariates# were per&ormed using aninteraction test as described by !ltman
"eterogeneity across studies wasevaluated using the I-s
-
7/23/2019 JR 2
9/18
REU/T
-
7/23/2019 JR 2
10/18
-
7/23/2019 JR 2
11/18
-
7/23/2019 JR 2
12/18
-
7/23/2019 JR 2
13/18
DICUION
Clinical Outcomes
9ood clinical outcome &or elderlypatients in our meta-anlysis is slightlyhigher than I!T patients treated withclipping or coiling
2oor outcome in our study is higherthan 3R!T
-
7/23/2019 JR 2
14/18
!ngiographic Outcome
The rates o& completeAnear completeocclusion at the )rst procedure alsoseems comparable to that observed
in the general population o& the IUI!study (B># but considerably lowerthan that observed in the I!T
(=;,>#;
-
7/23/2019 JR 2
15/18
/I.IT!TION
Data on clinical outcomes and long-term angiographic outcomes are limitedby the hetereogeneity in &ollow-up
the &act that the available evidence isobservational' nonrandomi1ed' andnoncomparative
Data in the published literature arecollected retrospectively' and detailsare o&ten lac%ing
-
7/23/2019 JR 2
16/18
9iven the low rate at which ad:unctdevices li%e balloons and stents wereused in this study an e@ect on the
generali1ability o& the results dicult to di@erentiate procedural-
related morbidity &rom morbidity
secondary to complications o& !" Our results were also associated with
the possibility o& publication bias
-
7/23/2019 JR 2
17/18
CONC/UION
Endovascular treatment o& I!s in theelderly is associated with high long-term occlusion rates
9iven the morbidity and mortalityassociated with endovasculartreatment o& I!s in the elderly' care&ul
patient selection' especially in thecase o& patients with unrupturedaneurysm' is recommended;
-
7/23/2019 JR 2
18/18
T"!N0 OU
