scholarly journals The 25th anniversary of the retrograde suction decompression technique (Dallas technique) for the surgical management of paraclinoid aneurysms: historical background, systematic review, and pooled analysis of the literature

2019 ◽  
Vol 130 (3) ◽  
pp. 902-916 ◽  
Author(s):  
Bruno C. Flores ◽  
Jonathan A. White ◽  
H. Hunt Batjer ◽  
Duke S. Samson
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
Neurological Outcome ◽  
Pooled Analysis ◽  
Morbidity And Mortality ◽  
Secondary Outcome ◽  
25Th Anniversary ◽  
Paraclinoid Aneurysms ◽  
Temporary Occlusion ◽  
The Mean

OBJECTIVEParaclinoid internal carotid artery (ICA) aneurysms frequently require temporary occlusion to facilitate safe clipping. Brisk retrograde flow through the ophthalmic artery and cavernous ICA branches make simple trapping inadequate to soften the aneurysm. The retrograde suction decompression (RSD), or Dallas RSD, technique was described in 1990 in an attempt to overcome some of those treatment limitations. A frequent criticism of the RSD technique is an allegedly high risk of cervical ICA dissection. An endovascular modification was introduced in 1991 (endovascular RSD) but no studies have compared the 2 RSD variations.METHODSThe authors performed a systematic review of MEDLINE/PubMed and Web of Science and identified all studies from 1990–2016 in which either Dallas RSD or endovascular RSD was used for treatment of paraclinoid aneurysms. A pooled analysis of the data was completed to identify important demographic and treatment-specific variables. The primary outcome measure was defined as successful aneurysm obliteration. Secondary outcome variables were divided into overall and RSD-specific morbidity and mortality rates.RESULTSTwenty-six RSD studies met the inclusion criteria (525 patients, 78.9% female). The mean patient age was 53.5 years. Most aneurysms were unruptured (56.6%) and giant (49%). The most common presentations were subarachnoid hemorrhage (43.6%) and vision changes (25.3%). The aneurysm obliteration rate was 95%. The mean temporary occlusion time was 12.7 minutes. Transient or permanent morbidity was seen in 19.9% of the patients. The RSD-specific complication rate was low (1.3%). The overall mortality rate was 4.2%, with 2 deaths (0.4%) attributable to the RSD technique itself. Good or fair outcome were reported in 90.7% of the patients.Aneurysm obliteration rates were similar in the 2 subgroups (Dallas RSD 94.3%, endovascular RSD 96.3%, p = 0.33). Despite a higher frequency of complex (giant or ruptured) aneurysms, Dallas RSD was associated with lower RSD-related morbidity (0.6% vs 2.9%, p = 0.03), compared with the endovascular RSD subgroup. There was a trend toward higher mortality in the endovascular RSD subgroup (6.4% vs 3.1%, p = 0.08). The proportion of patients with poor neurological outcome at last follow-up was significantly higher in the endovascular RSD group (15.4% vs 7.2%, p < 0.01).CONCLUSIONSThe treatment of paraclinoid ICA aneurysms using the RSD technique is associated with high aneurysm obliteration rates, good long-term neurological outcome, and low RSD-related morbidity and mortality. Review of the RSD literature showed no evidence of a higher complication rate associated with the Dallas technique compared with similar endovascular methods. On a subgroup analysis of Dallas RSD and endovascular RSD, both groups achieved similar obliteration rates, but a lower RSD-related morbidity was seen in the Dallas technique subgroup. Twenty-five years after its initial publication, RSD remains a useful neurosurgical technique for the management of large and giant paraclinoid aneurysms.

scholarly journals Interpositional Arthroplasty for Hallux Rigidus: A Systematic Review

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0012
Author(s):  
James Butler ◽  
Yoshiharu Shimozono ◽  
Arianna L Gianakos ◽  
John G Kennedy
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
Joint Space ◽  
Hallux Rigidus ◽  
Cochrane Library ◽  
Weighted Mean ◽  
Quality Of Evidence ◽  
Interpositional Arthroplasty ◽  
The Mean

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus is a common degenerative joint condition of the foot. In advanced stages of the disease, extensive procedures have been utilized including Keller arthroplasty, interpositional arthroplasty (IPA), arthrodesis, total joint replacement or synthetic cartilage replacement. IPA is a surgical procedure that attempts to maintain joint motion through insertion of a biologic spacer into the joint. However, there is still a paucity of overall clinical data regarding outcomes and complication rates following IPA procedure for the treatment of hallux rigidus.The purpose of the current study was to systematically review the outcomes of IPA in the treatment of hallux rigidus. Methods: A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes collected and analysed included: AOFAS score, VAS score, SF36 score, range of motion, radiographic parameters, and postoperative complications. The level and quality of evidence were recorded and assessed. Results: Sixteen studies with a total of 433 patients met inclusion/exclusion criteria. The mean AOFAS improved from 56.8±7.3 (range, 43.2-64.3) preoperatively to 84.0±6.7 (range, 71.6-90.0) postoperatively. The preoperative weighted mean total ROM was 37.7±16.2 degrees and the postoperative weighted mean total ROM was 60.3±13.4 degrees. Five studies examined joint space narrowing on plain radiographs. The mean preoperative joint space was 1.2±0.2 mm (range, 1 -1.5) and the mean postoperative joint space was 2.5±0.5 mm (range, 1.9-3). The complication rate was 18.2% with metatarsalgia as the most commonly reported complication. One study was Level III and 15 studies were Level IV. Conclusion: This systematic review demonstrates improvement in functional and ROM outcomes following IPA. The procedure however has a high complication rate. There is a low level and quality of evidence in the current literature with inconsistent reporting of data. Therefore, further well designed studies must be carried out to determine the efficacy of IPA in the treatment of hallux rigidus.

Vascularized Bone Grafting for Reconstruction of Oncologic Defects in the Spine: A Systematic Review and Pooled Analysis of the Literature

2018 ◽  
Vol 34 (09) ◽  
pp. 708-718 ◽  
Author(s):  
Rachel Pedreira ◽  
Charalampos Siotos ◽  
Brian Cho ◽  
Stella Seal ◽  
Deepa Bhat ◽  
...  
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
Bone Grafting ◽  
Tumor Resection ◽  
Pooled Analysis ◽  
Spinal Tumors ◽  
Johns Hopkins Hospital ◽  
Complication Rates ◽  
Spinal Reconstruction ◽  
Vascularized Bone

Background Resection of primary spinal tumors requires reconstruction for restoration of spinal column stability. Traditionally, some combination of bone grafting and instrumentation is implemented. However, delayed healing environments are associated with pseudoarthrodesis and failure. Implementation of vascularized bone grafting (VBG) to complement hardware may present a solution. We evaluated the use of VBG in oncologic spinal reconstruction via systematic review and pooled analysis of literature. Methods We searched PubMed/MEDLINE, Embase, Cochrane, and Scopus for studies published through September 2017 according to the PRISMA guidelines and performed a pooled analysis of studies with n > 5. Additionally, we performed retrospective review of patients at the Johns Hopkins Hospital that received spinal reconstruction with VBG. Results We identified 21 eligible studies and executed a pooled analysis of 12. Analysis indicated an 89% (95% confidence interval [CI]: 0.75–1.03) rate of successful union when VBG is employed after primary tumor resection. The overall complication rate was 42% (95% CI: 0.23–0.61) and reoperation rate was 27% (95% CI: 0.12–0.41) in the pooled cohort. Wound complication rate was 18% (95% CI: 0.11–0.26). Fifteen out of 209 patients (7.2%) had instrumentation failure and mean time-to-union was 6 months. Consensus in the literature and in the patients reviewed is that introduction of VBG into irradiated or infected tissue beds proves advantageous given decreased resorption, increased load bearing, and faster consolidation. Downsides to this technique included longer operations, donor-site morbidity, and difficulty in coordinating care. Conclusions Our results demonstrate that complication rates using VBG are similar to those reported in studies using non-VBG for similar spinal reconstructions; however, fusion rates are better. Given rapid fusion and possible hardware independence, VBG may be useful in reconstructing defects in patients with longer life expectancies and/or with a history of chemoradiation and/or infection at the site of tumor resection.

Proximal Interphalangeal Joint Arthrodesis Techniques: A Systematic Review

Hand ◽  
2021 ◽  
pp. 155894472199801
Author(s):  
Harrison Faulkner ◽  
Vincent An ◽  
Richard D. Lawson ◽  
David J. Graham ◽  
Brahman S. Sivakumar
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
English Language ◽  
Plate Fixation ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Complication Rates ◽  
Sample Proportion ◽  
The Mean ◽  
End Stage

Proximal interphalangeal joint (PIPJ) arthrodesis is a salvage option in the management of end-stage PIPJ arthropathy. Numerous techniques have been described, including screws, Kirschner wires, tension band wiring, intramedullary devices, and plate fixation. There remains no consensus as to the optimum method, and no recent summary of the literature exists. A literature search was conducted using the MEDLINE, EMBASE, and PubMed databases. English-language articles reporting PIPJ arthrodesis outcomes were included and presented in a systematic review. Pearson χ2 and 2-sample proportion tests were used to compare fusion time, nonunion rate, and complication rate between arthrodesis techniques. The mean fusion time ranged from 5.1 to 12.9 weeks. There were no statistically significant differences in fusion time between arthrodesis techniques. Nonunion rates ranged from 0.0% to 33.3%. Screw arthrodesis demonstrated a lower nonunion rate than wire fusion (3.0% and 8.5% respectively; P = .01). Complication rates ranged from 0.0% to 22.1%. Aside from nonunions, there were no statistically significant differences in complication rates between arthrodesis techniques. The available PIPJ arthrodesis techniques have similar fusion time, nonunion rate, and complication rate outcomes. The existing data have significant limitations, and further research would be beneficial to elucidate any differences between techniques.

scholarly journals Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Benjamin Gravesteijn ◽  
Marc Schluep ◽  
Maksud Disli ◽  
Prakriti Garkhail ◽  
Dinis Dos Reis Miranda ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Favourable Outcome ◽  
Secondary Outcome ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

Abstract BackgroundIn hospital cardiac arrest (IHCA) is a major adverse event with a high mortality rate if not treated appropriately. Extracorporeal cardiopulmonary resuscitation (ECPR), as adjunct to conventional cardiopulmonary resuscitation (CCPR) is a promising technique for IHCA treatment. Evidence pertaining to neurological outcomes after ECPR is still scarce. MethodsWe performed a comprehensive systematic search of all studies up to December 20th 2019. Our primary outcome was neurological outcome after ECPR at any moment after hospital discharge, defined by the Cerebral Performance Category (CPC) score. A score of 1 or 2 was defined as favourable outcome. Our secondary outcome was post-discharge mortality. A fixed-effects meta-analysis was performed. ResultsOur search yielded 1215 results, of which 19 studies were included in this systematic review. The average survival rate was 31% (95% CI: 28-33%, I2=0%, p=0.26). In the surviving patients, the pooled percentage of favourable neurological outcome was 83% (95% CI: 79-87%, I2=24%, p=0.75). ConclusionECPR as treatment for in-hospital cardiac arrest is associated with a large proportion of patients with good neurological outcome. The large proportion of favourable outcome could potentially be explained by the selection of patients for treatment using ECPR. Moreover, survival is higher than described in the conventional CPR literature. As indications for ECPR might extend to older or more fragile patient populations in the future, research should focus on increasing survival, while maintaining optimal neurological outcome.

scholarly journals Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Benjamin Gravesteijn ◽  
Marc Schluep ◽  
Maksud Disli ◽  
Prakriti Garkhail ◽  
Dinis Dos Reis Miranda ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Favourable Outcome ◽  
Secondary Outcome ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

Abstract Background: In hospital cardiac arrest (IHCA) is a major adverse event with a high mortality rate if not treated appropriately. Extracorporeal cardiopulmonary resuscitation (ECPR), as adjunct to conventional cardiopulmonary resuscitation (CCPR) is a promising technique for IHCA treatment. Evidence pertaining to neurological outcomes after ECPR is still scarce. Methods: We performed a comprehensive systematic search of all studies up to December 20th 2019. Our primary outcome was neurological outcome after ECPR at any moment after hospital discharge, defined by the Cerebral Performance Category (CPC) score. A score of 1 or 2 was defined as favourable outcome. Our secondary outcome was post-discharge mortality. A fixed-effects meta-analysis was performed. Results: Our search yielded 1215 results, of which 19 studies were included in this systematic review. The average survival rate was 30% (95% CI: 28-33%, I2=0%, p=0.24). In the surviving patients, the pooled percentage of favourable neurological outcome was 84% (95% CI: 80-88%, I2=24%, p=0.90). Conclusion: CPR as treatment for in-hospital cardiac arrest is associated with a large proportion of patients with good neurological outcome. The large proportion of favourable outcome could potentially be explained by the selection of patients for treatment using ECPR. Moreover, survival is higher than described in the conventional CPR literature. As indications for ECPR might extend to older or more fragile patient populations in the future, research should focus on increasing survival, while maintaining optimal neurological outcome.

scholarly journals A rapid systematic review of measures to protect older people in long-term care facilities from COVID-19

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e047012
Author(s):  
Kate Frazer ◽  
Lachlan Mitchell ◽  
Diarmuid Stokes ◽  
Ella Lacey ◽  
Eibhlin Crowley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Nursing Homes ◽  
Older People ◽  
Outcome Measures ◽  
Long Term Care ◽  
Morbidity And Mortality ◽  
Secondary Outcome ◽  
Term Care ◽  
Care Facilities

ObjectivesThe global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities (LTCF) experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in LTCF to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff and visitors.SettingLong-term care facilities.ParticipantsResidents, staff and visitors of facilities.Primary and secondary outcome measuresDatabases (PubMed, EMBASE, CINAHL, Cochrane Databases and repositories and MedRXiv prepublished database) were systematically searched from inception to 27 July 2020 to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted.ResultsThe search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2% to 85.4% in residents and 0.6% to 62.6% in staff. Mortality rates ranged from 5.3% to 55.3% in residents.ConclusionsNovel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in LTCF.PROSPERO registration numberCRD42020191569.

Clinical Outcomes and Complications of Primary Fingertip Reconstruction Using a Reverse Homodigital Island Flap: A Systematic Review

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Joshua Xu ◽  
Jacob Y. Cao ◽  
David J. Graham ◽  
Richard D. Lawson ◽  
Brahman S. Sivakumar
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
Functional Outcomes ◽  
Ring Finger ◽  
Flap Necrosis ◽  
Cold Intolerance ◽  
Ovid Medline ◽  
The Mean ◽  
Fingertip Reconstruction ◽  
Mean Time

Background Reverse homodigital island flaps (RHIFs) are increasingly used to reconstruct traumatic fingertip injuries, but there is limited evidence on the efficacy of this technique. We performed a systematic review of the literature to establish the safety and functional outcomes of RHIF for traumatic fingertip injuries. Methods Electronic searches were performed using 3 databases (PubMed, Ovid Medline, Cochrane CENTRAL) from their date of inception to April 2020. Relevant studies were required to report on complications and functional outcomes for patients undergoing RHIF for primary fingertip reconstruction. Data were extracted from included studies and analyzed. Results Sixteen studies were included, which produced a total cohort of 459 patients with 495 fingertip injuries. The index and middle fingers were involved most frequently (34.6% and 34.1%, respectively), followed by the ring finger (22%), the little finger (6.7%), and the thumb (2.6%). The mean postoperative static and moving 2-point discrimination was 7.2 and 6.7 mm, respectively. The mean time to return to work was 8.4 weeks. The mean survivorship was 98.4%, with the pooled complication rate being 28%. The pooled complication rate of complete flap necrosis was 3.6%, of partial flap necrosis was 10.3%, of venous congestion was 14.6%, of pain or hypersensitivity was 11.5%, of wound infection was 7.2%, of flexion contractures was 6.3%, and of cold intolerance was 17.7%. Conclusions Reverse homodigital island flaps can be performed safely with excellent outcomes. To minimize complications, care is taken during dissection and insetting, with extensive rehabilitation adhered to postoperatively. Prospective studies assessing outcomes of RHIF compared with other reconstruction techniques would be beneficial.

scholarly journals Laparoskopska resekcija jeter zaradi zasevkov raka debelega črevesa in danke – rezultati zdravljenja

2017 ◽  
Vol 86 (3-4) ◽  
Author(s):  
Arpad Ivanecz ◽  
Vid Pivec ◽  
Irena Plahuta ◽  
Bojan Krebs ◽  
Tomaž Jagrič ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Conversion Rate ◽  
Liver Tumors ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Morbidity And Mortality ◽  
Secondary Outcome ◽  
Estimated Blood Loss ◽  
The Mean

Background: In many referral centers, laparoscopic liver resection (LLR) is a well-established method for the management of colorectal liver metastases (CLM). The aim of this study is to review a single institution experience.Methods: Between April 2008 and September 2016, 58 patients underwent LLR for various benign and malignant liver tumors. The analysis included 12 patients operated on for CLM. The primary outcomes of this prospective non-randomized study included operative procedure and operating time (minutes), estimated blood loss (mL), conversion rate, R0 resections, resection margins (mm), length of hospital stay (days), post-operative morbidity, and mortality. The secondary outcome of the study was survival analysis.Results: Eight patients (67 %) had atypical LLR. The average operating time was 130 minutes (range 60–210 minutes). The mean estimated blood loss was 140 mL (range < 50–600 mL). In one patient LLR was converted to open procedure (conversion rate 8 %). Seven patients (58 %) had one liver metastasis. The mean metastasis size was 3.6 cm (range 1–9 cm). R0 resection was achieved in all cases. The mean resection margin was 6.8 mm (range 2–15 mm). Te mean length of hospital stay was 6 days (range 3–12 days). Morbidity and mortality rates were 0 %. The median follow-up for surviving patients was 13 months. Nine patients are alive with no evidence of disease, two patients are alive with disease and one patient died of disease.Conclusion: LLR is a feasible and safe method for the treatment of CLM and there is no compromise of oncological surgical principles.

scholarly journals Toxicoepidemiology of poisoning exhibited in Indian population from 2010 to 2020: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045182
Author(s):  
Chaitanya Mittal ◽  
Surjit Singh ◽  
Praveen Kumar-M ◽  
Shoban Babu Varthya
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
North India ◽  
Secondary Outcome ◽  
Pesticide Poisoning ◽  
North East ◽  
Poisoning In Children ◽  
Meta Analyses

ObjectiveTo determine the prevalence of pesticide, corrosive, drugs, venom and miscellaneous poisoning in India.SettingSystematic literature search was done in PubMed Central, Cochrane and Google Scholar databases for studies that satisfied the inclusion criteria. Systematic review and meta-analyses of all observational studies published in the English language from January 2010 to May 2020 were included in this review.ParticipantsPatients exposed to poisoning reported to hospitals were included.Primary and secondary outcome measuresThe prevalence of pesticide poisoning was analysed. The prevalence of poisoning due to corrosives, venom, drugs and miscellaneous agents, along with subgroup analysis based on age and region, was also determined. The percentage of persons with poisoning along with 95% CI was analysed.ResultsPooled analysis of studies revealed that pesticides were the main cause of poisoning in adults, with an incidence of 63% (95% CI 63% to 64%), while miscellaneous agents were the main cause of poisoning in children, with an incidence of 45.0% (95% CI 43.1% to 46.9%), among those presenting to hospitals. Pesticide poisoning was the most prevalent in North India (79.1%, 95% CI 78.4% to 79.9%), followed by South (65.9%, 95% CI 65.3% to 66.6%), Central (59.2%, 95% CI 57.9% to 60.4%), West (53.1%, 95% CI 51.9% to 54.2%), North East (46.9%, 95% CI 41.5% to 52.4%) and East (38.5%, 95% CI 37.3% to 39.7%). The second most common cause of poisoning was miscellaneous agents (18%, 95% CI 18% to 19%), followed by drugs (10%, 95% CI 10% to 10%), venoms (6%, 95% CI 6% to 6%) and corrosives (2%, 95% CI 1% to 2%).ConclusionsPesticide poisoning is the most common type of poisoning in adults, while miscellaneous agents remain the main cause of poisoning in children.PROSPERO registration numberCRD42020199427.

Abstract 1122‐000092: Safety and Efficacy of Dual Lumen Balloon Catheters for Neurointervention: Systematic Review and Pooled Analysis

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Stavros Matsoukas ◽  
Neha Siddiqui ◽  
Jacopo Scaggiante ◽  
Devin Bageac ◽  
Tomoyoshi Shigematsu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vascular Malformations ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Complication Rates ◽  
Unique Identifier ◽  
Safety And Efficacy ◽  
Balloon Catheters ◽  
Procedural Time ◽  
The Mean

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.

Sign in / Sign up

Export Citation Format

Share Document