Outcome and complications of endovascular embolization for vein of Galen malformations: a systematic review and meta-analysis

OBJECT There have been many multidisciplinary approaches to the treatment of vein of Galen malformations. Endovascular embolization is the first option for treatment. However, the effects of the treatment remain controversial. The aim of this study is to assess the efficacy and safety of endovascular embolization to treat patients with vein of Galen malformations. METHODS This paper includes a retrospective analysis of a sample of 667 patients who underwent endovascular embolization to treat vein of Galen malformations. The data were obtained through a literature search of PubMed databases. The authors also evaluate the efficacy and safety of the treatment. Mortality within the follow-up period is analyzed. Pooled estimates of proportions with corresponding 95% CIs were calculated using raw (i.e., untransformed) proportions (PRAW). RESULTS In the 34 studies evaluated, neonates accounted for 44% of the sample (95% CI 31%-57%; I2 = 92.5%), infants accounted for 41% (95% CI 30%–51%; I2 = 83.3%), and children and adults accounted for 12% (95% CI 7%–16%; I2 = 52.9%). The meta-analysis revealed that complete occlusion was performed in 57% (95% CI 48%–65%; I2 = 68.2%) of cases, with partial occlusion in 43% (95% CI 34%–51%; I2 = 70.7%). The pooled proportion of patients showing a good outcome was 68% (95% CI 61%–76%; I2 = 77.8%), while 31% showed a poor outcome (95% CI 24%–38%; I2 = 75.6%). The proportional meta-analysis showed that postembolization mortality and complications were reported in 10% (95% CI 8%–12%; I2 = 42.8%) and 37% (95% CI 29%–45%; I2 = 79.1%), respectively. Complications included cerebral hemorrhage, cerebral ischemia, hydrocephalus, leg ischemia, and vessel perforation. CONCLUSIONS The successful treatment of vein of Galen malformations remains a complex therapeutic challenge. The authors’ analysis of clinical history and research literature suggests that vein of Galen malformations treated with endovascular embolization can result in an acceptable mortality rate, complications, and good clinical outcome. Future large-scale, multicenter, randomized trials are necessary to confirm these findings.

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Efficacy and safety of Si-Jun-Zi-Tang-based therapies for functional (non-ulcer) dyspepsia: a meta-analysis of randomized controlled trials

BMC Complementary Medicine and Therapies ◽

10.1186/s12906-020-03176-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yaping Wang ◽

Bin Liu ◽

Xiuqiong Fu ◽

Tiejun Tong ◽

Zhiling Yu

Keyword(s):

Relapse Rate ◽

Large Scale ◽

Primary Outcome ◽

Response Rate ◽

Meta Analysis ◽

Risk Of Bias ◽

Efficacy And Safety ◽

History Of ◽

Non Ulcer Dyspepsia

Abstract Background The traditional Chinese medicine formula Si-Jun-Zi-Tang (SJZT) has a long history of application in the treatment of functional dyspepsia (non-ulcer dyspepsia, FD)-like symptoms. SJZT-based therapies have been claimed to be beneficial in managing FD. This study aimed to assess the efficacy and safety of SJZT-based therapies in treating FD by meta-analysis. Methods Systematic searches for RCTs were conducted in seven databases (up to February 2019) without language restrictions. Data were analyzed using Cochrane RevMan software version 5.3.0 and Stata software version 13.1, and reported as relative risk (RR) or odds ratio (OR) with 95% confidence intervals (CIs). The primary outcome was response rate and the secondary outcomes were gastric emptying, quality of life, adverse effects and relapse rate. The quality of evidence was evaluated according to criteria from the Cochrane risk of bias. Results A total of 341 potentially relevant publications were identified, and 12 RCTs were eligible for inclusion. For the response rate, there was a statically significant benefit in favor of SJZT-based therapies (RR = 1.23; 95% CI 1.17 to 1.30). However, the benefit was limited to modified SJZT (MSJZT). The relapse rate of FD patients received SJZT-based therapies was lower than that of patients who received conventional medicines (OR = 0.23; 95% CI 0.10 to 0.51). No SJZT-based therapies-related adverse effect was reported. Conclusion SJZT-based prescriptions may be effective in treating FD and no serious side-effects were identified, but the effect on response rate appeared to be limited to MSJZT. The results should be interpreted with caution as all the included studies were considered at a high risk of bias. Standardized, large-scale and strictly designed RCTs are needed to further validate the benefits of SJZT-based therapies for FD management. Trial registration Systematic review registration: [PROSPERO registration: CRD42019139136].

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Dural Arteriovenous Shunt Development in Patients with Vein of Galen Malformation

Interventional Neuroradiology ◽

10.15274/inr-2014-10066 ◽

2014 ◽

Vol 20 (6) ◽

pp. 781-790 ◽

Cited By ~ 6

Author(s):

Srinivasan Paramasivam ◽

Yasunari Niimi ◽

Dan Meila ◽

Alejandro Berenstein

Keyword(s):

Dura Mater ◽

Endovascular Embolization ◽

External Carotid ◽

Vein Of Galen ◽

Arteriovenous Fistulas ◽

Sprouting Angiogenesis ◽

Multi Stage ◽

Dural Arteriovenous Shunt ◽

Age Range

Dural arteriovenous fistulas (DAVF) associated with our series of patients with vein of Galen malformations (VOGM) are analyzed and discussed. We retrospectively analyzed 87 consecutive cases of VOGM treated between May 2002 and December 2011 and identified 26 patients with DAVF. We gathered information from the clinical case records, angiographic images, MRI on presentation and during follow-up. The findings were analyzed to aid discussion. Among 87 patients treated by multi-stage endovascular embolization, age range from newborn to 19 years, 26 (30%) had DAVF. In seven patients (8%), DAVF were found on initial angiogram and were all into the VOGM. Nineteen (21%) DAVF found on follow-up angiograms were all into the VOGM and distant locations. Sprouting and non-sprouting angiogenesis resulted in the formation of a network of vessels around partially thrombosed VOGM, recruiting blood from the surrounding dura mater resulting in a secondary network on the dura mater supplied by the blood vessels of dura mater in the region or from its natural collaterals. Embolization targeting DAVFs was done in 13 (52%) with complete cure in eight (32%) and recurrence in five (20%). Among 12 non-embolized patients (48%), eight (32%) had spontaneous regression with continued treatment of VOGM. In others, the DAVF either remained stable or progressed. DAVF associated with VOGM represent the dural response to angiogenic stimuli. They are observed to regress spontaneously or mature while continuing to treat the primary feeders of VOGM. It is important to include the external carotid system during angiograms. Persistent DAVF with residual VOGM that do not have access though the pial vessels are used as a conduit to treat the dural shunt and to achieve obliteration of residual VOGM at later stages of treatment.

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Efficacy and Safety of Galantamine Hydrobromide in the Treatment of Mild to Moderate Dementia

Clinical Medicine Insights Therapeutics ◽

10.4137/cmt.s5884 ◽

2010 ◽

Vol 2 ◽

pp. CMT.S5884

Author(s):

Mark Oremus ◽

Pasqualina Santaguida ◽

Parminder Raina

Keyword(s):

Daily Living ◽

Meta Analysis ◽

Risk Of Bias ◽

Disease Course ◽

Efficacy And Safety ◽

Screening Process ◽

Global Function ◽

Randomized Controlled ◽

Moderate Dementia

We conducted a systematic review and meta analysis of randomized controlled trials of galantamine hydrobromide in the treatment of mild to moderate dementia. Following a literature search and screening process, we included 15 trials and five companion papers in the review. Moderate-quality evidence suggested galantamine-treated persons generally had better outcomes than placebo-treated persons after a maximum 6-month follow-up. Outcome domains included cognitive function, global function, behaviour and mood, and activities of daily living. The evidence requires careful interpretation because ‘better outcomes’ can mean less deterioration, rather than improvement, relative to placebo. Galantamine has not been shown to halt dementia progression nor reverse disease course. The most frequently reported harms were nausea, diarrhea, and dizziness. Reported rates of these harms were highly variable (range, 0%–40%); reporting was at high risk of bias because authors rarely specified the frequency or timing of harms assessment, nor did they report active methods of collecting harms.

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Nafarelin for endometriosis: A large-scale, danazol-controlled trial of efficacy and safety, with 1-year follow-up

International Journal of Gynecology & Obstetrics ◽

10.1016/0020-7292(92)90702-k ◽

1992 ◽

Vol 39 (3) ◽

pp. 256-256

Author(s):

M Elstein ◽

K Bancroft ◽

R Rolland ◽

T Van der Heijden ◽

D Barlow ◽

...

Keyword(s):

Large Scale ◽

Controlled Trial ◽

Efficacy And Safety

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Efficacy and safety of drug-eluting balloon-only strategy (DEB-only) for de novo coronary artery disease: a systematic review and meta-analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.2548 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

W.Y Zhang ◽

M.D Zhang ◽

J.F Tian ◽

M Zhang ◽

Y Zhou ◽

...

Keyword(s):

De Novo ◽

Meta Analysis ◽

Controlled Trials ◽

Efficacy And Safety ◽

Late Lumen Loss ◽

Drug Eluting ◽

Coronary Lesions ◽

Artery Disease ◽

Drug Eluting Balloon

Abstract Background Many clinical trials have demonstrated the value of drug-eluting balloon (DEB) for in-stent restenosis. Recently, DEB for de novo lesions has also attracted more attention. There have been promising results of PCI using DEB alone in selected de novo coronary diseases (small vessels, bifurcating lesions, acute myocardial infarction). However, the application of DEB for patients with de novo coronary artery disease remains controversial due to relatively limited evidence. Purpose The purpose of this study was to evaluate the efficacy and safety DEB-only strategy (bail-out stents were allowed when required) compared with other modalities for the treatment of de novo coronary lesions. Methods We searched PubMed, Embase, Web of Science and Cochrane Library Central Register of Controlled Trials (CENTRAL) electronic databases for randomized controlled trials as well as observational studies published up to Jan 22, 2020. Studies which compared DEB-only approach with other PCI strategies for treatment of any type of de novo coronary lesions were identified. The primary outcome was late lumen loss (LLL) during angiographic follow up. The secondary outcomes were major adverse cardiac events (MACE), target lesion revascularisation (TLR) and binary in-segment restenosis. Results Nineteen studies (eleven randomised controlled trials and eight observational studies) with a total of 3,356 patients were included in this meta-analysis. Angiographic observations were obtained at 6 or 9 months and clinical follow-up duration ranged from 6 months to 36 months. Among the overall studies, the results indicated that DEB-only strategy was superior to the control groups for LLL (mean difference (MD) = −0.30mm; 95% confidence interval (CI), −0.41 to −0.19; P<0.001). DEBs were associated with a similar risk of MACE (risk ratio (RR): 0.84, 95% CI: 0.64, 1.11, P=0.22), TLR (RR: 0.79, 95% CI: 0.53, 1.16, P=0.23) and binary restenosis (RR: 0.68, 95% CI: 0.35, 1.31, P=0.25) compared with the control groups. In subgroup analysis, DEB-only strategy showed significantly better outcomes for most endpoints compared to POBA. Compared with DES, there were also significant favorable effects associated with treatment of DEB-only on LLL (MD: −0.14, 95% CI: −0.23, −0.04, P=0.005), while insignificant inter-strategy differences were observed in other endpoints. Vessel diameter did not have a significant influence on the result. Conclusion DEB-only intervention is an effective treatment associated with a significant reduction in late loss late lumen loss compared to other options. The efficacy and safety of DEB alone are comparable to those of DES and superior to POBA for treatment of selected de novo coronary lesions. Additional evidence is still warranted to confirm value of DEB before a widespread clinical utilization can be recommended. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Beijing Lab for Cardiovascular Precision Medicine

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Efficacy and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: a systematic review and meta-analysis

Endoscopy International Open ◽

10.1055/a-0996-8178 ◽

2019 ◽

Vol 07 (11) ◽

pp. E1474-E1482 ◽

Cited By ~ 9

Author(s):

Thomas R. McCarty ◽

Rajat Garg ◽

Christopher C. Thompson ◽

Tarun Rustagi

Keyword(s):

Gastric Outlet Obstruction ◽

Clinical Success ◽

Meta Analysis ◽

Outlet Obstruction ◽

Clinical Success Rate ◽

Cochrane Library ◽

Efficacy And Safety ◽

Serious Adverse Events ◽

Malignant Gastric Outlet Obstruction

Abstract Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel endoscopic procedure designed to facilitate sustained luminal patency in patients with gastric outlet obstruction. The primary aim of this study was to evaluate the efficacy and safety of EUS-GE for treatment of gastric outlet obstruction. Methods Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed through April 2019. Patients with benign and malignant gastric outlet obstruction were included. Measured outcomes included: immediate technical and clinical success as well as rate of serious adverse events (AEs). Heterogeneity was assessed with Cochran Q test and I 2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing. Results A total of five studies (n = 199 patients; 45.73 % male) were included in this study. Four retrospective studies and one prospective study were analyzed. Mean age of patients that underwent the EUS-GE procedure was 64.52 ± 1.37 years with a pooled mean follow-up period of 4.32 ± 1.65 months. In 21 % of patients (n = 43), gastric outlet obstruction was due to benign causes. Immediate technical success was 92.90 % (95 % CI; 88.26 – 95.79; I2 = 0.00 %) and reported in all studies. The clinical success rate of EUS-GE was 90.11 % (95 % CI; 84.64 – 93.44; I2 = 0.00 %). Serious AEs occurred in 5.61 % (95 % CI; 2.87 – 10.67; I2 = 1.67 %) of cases and were related to peritonitis, perforation, bleeding, and abdominal pain. Re-intervention rate was 11.43 % (95 % CI; 7.29 – 17.46; I2 = 17.38 %). Conclusions EUS-GE appears to provide an effective and safe minimally invasive alternative for treatment of benign and malignant gastric outlet obstruction.

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Efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm—A systematic review and meta-analysis

Interventional Neuroradiology ◽

10.1177/1591019920940521 ◽

2020 ◽

pp. 159101992094052 ◽

Cited By ~ 1

Author(s):

Raymond Pranata ◽

Emir Yonas ◽

Rachel Vania ◽

Prijo Sidipratomo ◽

Julius July

Keyword(s):

Systematic Review ◽

Intracranial Aneurysm ◽

Thrombus Formation ◽

Meta Analysis ◽

Class Ii ◽

Aneurysm Rupture ◽

Class I ◽

Efficacy And Safety ◽

Vessel Dissection

Objective PulseRider is a novel self-expanding nickel-titanium (nitinol) stent for treatment of wide-necked aneurysms, which is commonly located at the arterial branches in the brain. This systematic review and meta-analysis aims to assess the efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm. Method We performed a systematic literature search on articles that evaluate the efficacy and safety of PulseRider-assisted coiling of the wide-necked aneurysm from several electronic databases. The primary endpoint was adequate occlusion, defined as Raymond-Roy Class I + Raymond-Roy Class II upon immediate angiography and at six-month follow-up. Results There were a total of 157 subjects from six studies. The rate of adequate occlusion on immediate angiography was 90% (95% CI, 85%–94%) and 91% (95% CI, 85%–96%) at six-month follow-up. Of these, Raymond-Roy Class I can be observed in 48% (95% CI, 41%–56%) of aneurysms immediately after coiling, and 64% (95% CI, 55%–72%) of aneurysms on six-month follow-up. Raymond-Roy Class II was found in 30% (95% CI, 23%–37%) of aneurysms immediately after coiling, and 25% (17–33) after six-month follow-up. Complications occur in 5% (95% CI, 1%–8%) of the patients. There were three intraoperative aneurysm rupture, three thrombus formation, three procedure-related posterior cerebral artery strokes, one vessel dissection, and one delayed device thrombosis. There was no procedure/device-related death. Conclusions PulseRider-assisted coiling for treatment of patients with wide-necked aneurysm reached 90% adequate occlusion rate that rises up to 91% at sixth month with 5% complication rate.

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Efficacy and Safety of the TCM Qi-Supplementing Therapy in Patients with Myasthenia Gravis: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2017/6512572 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Xi-qian Yang ◽

Ling Liu ◽

Wen-yu Yang ◽

Huan-huan Dong ◽

Yi-ran Yang ◽

...

Keyword(s):

Adverse Events ◽

Myasthenia Gravis ◽

Relapse Rate ◽

Response Rate ◽

Meta Analysis ◽

Effective Rate ◽

Efficacy And Safety ◽

Total Response ◽

Total Response Rate

Background. The Traditional Chinese Medicine (TCM) Qi-supplementing therapy has been used widely for treating myasthenia gravis (MG) in China. The purpose of this meta-analysis was to evaluate the efficacy and safety of Qi-supplementing therapy as an adjunctive therapy in MG patients. Methods. Seven electronic databases were searched through June 2016. Randomized controlled trials (RCTs) evaluating the add-on effect of Qi-supplementing therapy in MG patients were included. The outcome measures were the total effective rate, relapse rate, and adverse events. Results. Twenty-three RCTs involving 1,691 MG patients were included. The included studies were of low-to-moderate quality. Meta-analysis showed that Qi-supplementing therapy combined with Western medicine (WM) significantly improved the total response rate and reduced the relapse risk during 6–24 months of follow-up. Subgroup analysis showed that Qi-supplementing therapy only affected the total response rate within the first 6 months of treatment. Moreover, the rate of adverse events was lower with the addition of Qi-supplementing therapy to WM than with WM only. Conclusions. Short-term Qi-supplementing therapy combined with WM appears to be superior to WM for improving the total response rate and reducing the relapse rate. However, more high-quality RCTs are warranted owing to methodological flaws of previous trials.

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Efficacy and Safety of Combined Endovascular Embolization and Stereotactic Radiosurgery for Patients with Intracranial Arteriovenous Malformations: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2021/6686167 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Zhiqun Jiang ◽

Xuezhi Zhang ◽

Xichen Wan ◽

Minjun Wei ◽

Yue Liu ◽

...

Keyword(s):

Sensitivity Analysis ◽

Stereotactic Radiosurgery ◽

Arteriovenous Malformations ◽

Meta Analysis ◽

Endovascular Embolization ◽

Neurological Deficits ◽

Cochrane Library ◽

Efficacy And Safety ◽

Intracranial Arteriovenous Malformations ◽

Obliteration Rate

Whether the use of endovascular embolization could provide additional benefits in patients treated with stereotactic radiosurgery (SRS) for intracranial arteriovenous malformations (IAVMs) remains controversial. The current meta-analysis was conducted to assess the efficacy and safety of SRS with and without prior endovascular embolization in patients with IAVMs. The electronic databases of PubMed, EmBase, and Cochrane Library were systematically searched for eligible studies published from inception to August 12, 2020. The pooled results for obliteration rate, rehemorrhage rate, and permanent neurological deficits were calculated by odds ratios (ORs) with 95% confidence intervals (CIs) using the random-effects model. The sensitivity analysis, subgroup analysis, and publication bias for investigated outcomes were also evaluated. Nineteen studies (two prospective and 17 retrospective studies) involving a total of 3,454 patients with IAVMs were selected for the final meta-analysis. We noted that prior embolization and SRS were associated with a lower obliteration rate compared with SRS alone (OR, 0.57; 95% CI, 0.44–0.74; P < 0.001 ). However, prior embolization and SRS were not associated with the risk of rehemorrhage (OR, 1.05; 95% CI, 0.81–1.34; P = 0.729 ) and permanent neurological deficits (OR, 0.80; 95% CI, 0.48–1.33; P = 0.385 ) compared with SRS alone. The sensitivity analysis suggested that prior embolization might reduce the risk of permanent neurological deficits in patients with IAVMs treated with SRS. The treatment effects of prior embolization in patients with IAVMs could be affected by nidus volume, margin dose, intervention, and follow-up duration. This study found that prior embolization was associated with a reduced risk of obliteration in patients with IAVMs treated with SRS. Moreover, prior embolization might reduce the risk of permanent neurological deficits in patients with IAVMs.

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Efficacy and safety of bevacizumab in the treatment of adult gliomas: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2021-048975 ◽

2021 ◽

Vol 11 (12) ◽

pp. e048975

Author(s):

Huan Wang ◽

Jianxin Guo ◽

Tianze Wang ◽

Kai Wang ◽

Zhuojun Wu ◽

...

Keyword(s):

Systematic Review ◽

Large Scale ◽

Meta Analysis ◽

Progression Free Survival ◽

Optimal Dose ◽

Secondary Outcome ◽

Efficacy And Safety ◽

Free Survival ◽

Significant Difference ◽

Clinical Centre

ObjectiveTo assess the efficacy and safety of bevacizumab (BEV) in patients with glioma.DesignSystematic review and meta-analysis.ParticipantsAdults aged 18 years and above, whose histology was confirmed to be malignant glioma.Primary and secondary outcome measuresThe main indicators included progression-free survival (PFS) rate and overall survival (OS) rate, and the secondary indicators were adverse reactions.ResultsA total of 11 clinical centre trials were included in this study for meta-analysis, including 2392 patients. The results of the meta-analysis showed that the median PFS rate of the BEV group was significantly higher than that of the non-BEV group (p<0.00001). When comparing PFS between two groups, we found that the PFS in the BEV group was higher than that in the non-BEV group at 6 months (OR 3.31, 95% CI 2.74 to 4.00, p<0.00001), 12 months (OR 2.05, 95% CI 1.70 to 2.49, p<0.00001) and 18 months (OR 1.31, 95% CI 1.02 to 1.69, p=0.03). But at 24 months (OR 0.83, 95% CI 0.50 to 1.37, p=0.47), there was no significant difference between the two groups. At 30 months (OR 0.62, 95% CI 0.39 to 0.97, p=0.04), the PFS of the BEV group was lower than that of the non-BEV group. Moreover, The results showed that BEV had no significant effect on improving OS, but the adverse reaction in BEV group was significantly higher than that in non-BEV group.ConclusionThe evidence suggests that BEV can significantly prolong the PFS of patients with glioma within 18 months and shorten the PFS of patients after 30 months. This limitation may be related to the subgroup of patients, the change of recurrence mode, the optimal dose of drug, the increase of hypoxia, the enhancement of invasiveness and so on. Therefore, it is necessary to carry out more samples and higher quality large-scale research in the future.

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