Introduction
: Dual‐lumen balloon catheters (DLBCs) are used routinely in the endovascular treatment of cerebral vascular malformations and reportedly, they have been noted to present significant advantages compared to single‐lumen catheters (SLCs). We conducted a systematic review and a pooled analysis in order to assess DLBCs’ overall safety and efficacy and complication rates.
Methods
: In this PROSPERO registered, PRISMA compliant systematic review, we sought to identify all MEDLINE and EMBASE published single‐arm (DLBCs) and double‐arm (DLBCs versus SLCs) cohorts where DLBCs were used for the treatment of cerebral arteriovenous malformations (AVMs) and dural arteriovenous fistulas (dAVFs). A pooled analysis was conducted for the included single‐arm studies. Immediate angiographic outcome, complications related to the catheter, reflux episodes and entrapment were the primary outcomes, summarized in the pooled analysis. Secondary outcomes included mortality and reported navigability. A meta‐analysis of the double‐arm studies summarized the primary outcomes of total procedural time and immediate angiographic outcome. Registration‐URL:
https://www.crd.york.ac.uk/prospero/
Unique Identifier: CRD42021269096
Results
: Of the 298 records that were screened by title and abstract, 24 underwent full‐text review. Ultimately, 19 studies were included and combined into a pooled analysis. Of the 227 lesions that were treated, complete (100%) nidal occlusion was achieved in 171 (75%; 95% CI: [69.1‐80.7%]), near‐complete (90‐99%) in 18 (8%; [4.9‐12.4%]), partial/incomplete (25‐89%) in 36 (16%; [11.5‐21.4%]) and none (<25%) in 2 (1%; [0.2‐3.5%]). In total, 13 complications related to the catheter were reported (5.73%; [3.2‐9.8%]), 14 reflux events (6%; [1.9‐10.4%]), 2 entrapment events (1%; [0.2‐3.5%]) and 0 deaths (mortality rate 0%; [0‐2.1%]). Based on two independent reviewers, the navigability of the catheter was judged to be reported as “very good” in 4 studies, “subjectively good” in 9, “slightly more difficult than SLCs” in 5 and “significantly more difficult than SLCs” in 1 study.
Of the 19 included studies, only two were double‐armed and combined into a meta‐analysis. The mean total procedural time (SD) was 64.9 minutes (37.5) for DLBCs compared to 125.7 (81.8) for SLCs (P<0.0001), while complete nidal occlusion was noted in 39/45 (86.7%; [72.5‐94.5%]) with the DLBCs compared to 17/29 (58.6%; [39.1‐75.9%]) with the SLCs (P = 0.00596), when only dAVFs where combined. The mean total procedural time was 65.5 minutes (39.1) for DLBCs compared to 106.2 (78.3) for SLCs (P = 0.001), while complete nidal occlusion was noted in 46/59 (78%; [65‐87.3%]) with the DLBCs compared to 52/69 (75.3%; [63.3‐84.6%]) with the SLCs (P = 0.726), when both AVMs and dAVFs where combined.
Conclusions
: DLBCs are safe and effective for the embolization of cerebral AVMs and dAFVs. More importantly, they can achieve faster and potentially superior results compared to SLCs, when used in the appropriate context. A lack of well‐designed controlled comparative studies has been identified in the literature.
Complications of Outpatient and Inpatient Renal Biopsy: A Systematic Review and Meta-Analysis
