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Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW)

Background: patients with a subarachnoid hemorrhage (SAH) might need a flow diverter (FD) placement for complex acutely ruptured intracranial aneurysms (IAs). We conducted a meta-analysis and developed a prediction model to estimate the favorable clinical outcome after the FD treatment in acutely ru...

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Autores principales: ten Brinck, Michelle F. M., Shimanskaya, Viktoria E., Aquarius, René, Bartels, Ronald H. M. A., Meijer, Frederick J. A., Koopmans, Petra C., de Jong, Guido, Wakhloo, Ajay K., de Vries, Joost, Boogaarts, Hieronymus D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8946659/
https://www.ncbi.nlm.nih.gov/pubmed/35326350
http://dx.doi.org/10.3390/brainsci12030394
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author ten Brinck, Michelle F. M.
Shimanskaya, Viktoria E.
Aquarius, René
Bartels, Ronald H. M. A.
Meijer, Frederick J. A.
Koopmans, Petra C.
de Jong, Guido
Wakhloo, Ajay K.
de Vries, Joost
Boogaarts, Hieronymus D.
author_facet ten Brinck, Michelle F. M.
Shimanskaya, Viktoria E.
Aquarius, René
Bartels, Ronald H. M. A.
Meijer, Frederick J. A.
Koopmans, Petra C.
de Jong, Guido
Wakhloo, Ajay K.
de Vries, Joost
Boogaarts, Hieronymus D.
author_sort ten Brinck, Michelle F. M.
collection PubMed
description Background: patients with a subarachnoid hemorrhage (SAH) might need a flow diverter (FD) placement for complex acutely ruptured intracranial aneurysms (IAs). We conducted a meta-analysis and developed a prediction model to estimate the favorable clinical outcome after the FD treatment in acutely ruptured IAs. Methods: a systematic literature search was performed from 2010 to January 2021 in PubMed and Embase databases. Studies with more than five patients treated with FDs within fifteen days were included. In total, 1157 studies were identified. The primary outcome measure was the favorable clinical outcome (mRS 0–2). Secondary outcome measures were complete occlusion rates, aneurysm rebleeding, permanent neurologic deficit caused by procedure-related complications, and all-cause mortality. A prediction model was constructed using individual patient-level data. Results: 26 retrospective studies with 357 patients and 368 aneurysms were included. The pooled rates of the favorable clinical outcome, mortality, and complete aneurysm occlusion were 73.7% (95% CI 64.7–81.0), 17.1% (95% CI 13.3–21.8), and 85.6% (95% CI 80.4–89.6), respectively. Rebleeding occurred in 3% of aneurysms (11/368). The c-statistic of the final model was 0.83 (95% CI 0.76–0.89). All the studies provided a very low quality of evidence. Conclusions: FD treatment can be considered for complex ruptured IAs. Despite high complication rates, the pooled clinical outcomes seem favorable. The prediction model needs to be validated by larger prospective studies before clinical application.
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spelling pubmed-89466592022-03-25 Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW) ten Brinck, Michelle F. M. Shimanskaya, Viktoria E. Aquarius, René Bartels, Ronald H. M. A. Meijer, Frederick J. A. Koopmans, Petra C. de Jong, Guido Wakhloo, Ajay K. de Vries, Joost Boogaarts, Hieronymus D. Brain Sci Review Background: patients with a subarachnoid hemorrhage (SAH) might need a flow diverter (FD) placement for complex acutely ruptured intracranial aneurysms (IAs). We conducted a meta-analysis and developed a prediction model to estimate the favorable clinical outcome after the FD treatment in acutely ruptured IAs. Methods: a systematic literature search was performed from 2010 to January 2021 in PubMed and Embase databases. Studies with more than five patients treated with FDs within fifteen days were included. In total, 1157 studies were identified. The primary outcome measure was the favorable clinical outcome (mRS 0–2). Secondary outcome measures were complete occlusion rates, aneurysm rebleeding, permanent neurologic deficit caused by procedure-related complications, and all-cause mortality. A prediction model was constructed using individual patient-level data. Results: 26 retrospective studies with 357 patients and 368 aneurysms were included. The pooled rates of the favorable clinical outcome, mortality, and complete aneurysm occlusion were 73.7% (95% CI 64.7–81.0), 17.1% (95% CI 13.3–21.8), and 85.6% (95% CI 80.4–89.6), respectively. Rebleeding occurred in 3% of aneurysms (11/368). The c-statistic of the final model was 0.83 (95% CI 0.76–0.89). All the studies provided a very low quality of evidence. Conclusions: FD treatment can be considered for complex ruptured IAs. Despite high complication rates, the pooled clinical outcomes seem favorable. The prediction model needs to be validated by larger prospective studies before clinical application. MDPI 2022-03-15 /pmc/articles/PMC8946659/ /pubmed/35326350 http://dx.doi.org/10.3390/brainsci12030394 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
ten Brinck, Michelle F. M.
Shimanskaya, Viktoria E.
Aquarius, René
Bartels, Ronald H. M. A.
Meijer, Frederick J. A.
Koopmans, Petra C.
de Jong, Guido
Wakhloo, Ajay K.
de Vries, Joost
Boogaarts, Hieronymus D.
Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW)
title Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW)
title_full Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW)
title_fullStr Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW)
title_full_unstemmed Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW)
title_short Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW)
title_sort outcomes after flow diverter treatment in subarachnoid hemorrhage: a meta-analysis and development of a clinical prediction model (outflow)
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8946659/
https://www.ncbi.nlm.nih.gov/pubmed/35326350
http://dx.doi.org/10.3390/brainsci12030394
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