Willis Covered Stent Treatment for Internal Carotid Artery Pseudoaneurysm: A Meta-analysis of Efficacy and Safety

Overview

Journal Heliyon

Specialty Social Sciences

Date 2023 Dec 11

PMID 38076066

Authors

Jiahe Tan

Rui Song

Siyue Luo

Yinrui Ma

Jun Su

Baoping Qin

Zhaohui He

Affiliations

Soon will be listed here.

Abstract

Background: Pseudoaneurysm (PSA) of internal carotid artery is a rare but severe cerebrovascular disease and difficult to repair surgically. A novel medical device called Willis covered stent (WCS) has been created especially for the treatment of complex cerebrovascular diseases. However, the efficacy and safety of WCS therapy for PSA are still debatable. Additional substantial proof is needed.

Methods: To find research pertaining to WCS treatment for PSA, a systematic review of literature was conducted in the Medline, Embase, Web of Science, CNKI, Wanfang, and CBM databases. The results comprising the data of intraoperative situation, postoperative situation, and follow-up were then included in a meta-analysis.

Results: The criteria were met by 11 noncomparative studies with 152 patients and 157 PSAs. Technical success rate was nearly 100 % (>0.999 (95 % confidence interval (CI), 0.958, 1.000)), complete occlusion rate was 97.8 % (95 % CI, 0.932, 1.000), and side branch occlusion rate was 0.5 % (95 % CI, 0.001, 0.045). The rates of acute in-stent thrombosis (<0.001 (95 % CI, 0.000, 0.013)) and hemorrhage (<0.001 (95 % CI, 0.000, 0.005)) were both less than 0.1 %. In postoperative situation, surgery-related mortality rate was less than 0.1 % (<0.001 (95 % CI, 0.000, 0.005)). The rates of recurrence (<0.001 (95 % CI, 0.000, 0.002)) and parent artery stenosis (<0.001 (95 % CI, 0.000, 0.008)) were both less than 0.1 %, while late in-stent stenosis occurred in 1.3 % (95 % CI, 0.000, 0.053) of patients. In the end, 98.5 % (95 % CI, 0.943, 1.000) of patients had a good outcome.

Conclusion: The application of WCS could be effective and safe for PSAs. The findings of this study could serve as a reference for upcoming clinical trials.

References

Rubin R . New AHRQ Patient Safety Guidance. JAMA. 2020; 323(16):1542. DOI: 10.1001/jama.2020.5603. View

Kan P, Duckworth E, Puri A, Velat G, Wakhloo A . Treatment failure of fetal posterior communicating artery aneurysms with the pipeline embolization device. J Neurointerv Surg. 2015; 8(9):945-8. DOI: 10.1136/neurintsurg-2015-011959. View

Wang K, Peng X, Liu A, Zhang Y, Lv J, Xiang L . Covered Stenting Is an Effective Option for Traumatic Carotid Pseudoaneurysm with Promising Long-Term Outcome. J Korean Neurosurg Soc. 2020; 63(5):590-597. PMC: 7477158. DOI: 10.3340/jkns.2019.0202. View

Li M, Li Y, Gao B, Fang C, Luo Q, Cheng Y . A new covered stent designed for intracranial vasculature: application in the management of pseudoaneurysms of the cranial internal carotid artery. AJNR Am J Neuroradiol. 2007; 28(8):1579-85. PMC: 8134415. DOI: 10.3174/ajnr.A0668. View

Chen S, McCarthy D, Sheinberg D, Hanel R, Sur S, Jabbour P . Pipeline Embolization Device for the Treatment of Intracranial Pseudoaneurysms. World Neurosurg. 2019; 127:e86-e93. DOI: 10.1016/j.wneu.2019.02.135. View

Shea B, Reeves B, Wells G, Thuku M, Hamel C, Moran J . AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017; 358:j4008. PMC: 5833365. DOI: 10.1136/bmj.j4008. View

Nyaga V, Arbyn M, Aerts M . Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health. 2015; 72(1):39. PMC: 4373114. DOI: 10.1186/2049-3258-72-39. View

Ioannidis J . Interpretation of tests of heterogeneity and bias in meta-analysis. J Eval Clin Pract. 2008; 14(5):951-7. DOI: 10.1111/j.1365-2753.2008.00986.x. View

Deng Q, Feng W . Efficacy of pipeline endovascular device and Willis stent graft in the treatment of traumatic pseudo intracranial aneurysms. J Interv Med. 2021; 3(1):45-48. PMC: 8562160. DOI: 10.1016/j.jimed.2020.01.007. View

10.

Lu D, Ma T, Zhu G, Zhang T, Wang N, Lei H . Willis Covered Stent for Treating Intracranial Pseudoaneurysms of the Internal Carotid Artery: A Multi-Institutional Study. Neuropsychiatr Dis Treat. 2022; 18:125-135. PMC: 8811267. DOI: 10.2147/NDT.S345163. View

11.

Zheng Y, Lu Z, Shen J, Xu F . Intracranial Pseudoaneurysms: Evaluation and Management. Front Neurol. 2020; 11:582. PMC: 7358534. DOI: 10.3389/fneur.2020.00582. View

12.

Perrini P, Cardia A, Fraser K, Lanzino G . A microsurgical study of the anatomy and course of the ophthalmic artery and its possibly dangerous anastomoses. J Neurosurg. 2007; 106(1):142-50. DOI: 10.3171/jns.2007.106.1.142. View

13.

Larson P, Reisner A, Morassutti D, Abdulhadi B, Harpring J . Traumatic intracranial aneurysms. Neurosurg Focus. 2006; 8(1):e4. DOI: 10.3171/foc.2000.8.1.1829. View

14.

Morton R, Levitt M, Emerson S, Ghodke B, Hallam D, Sekhar L . Natural History and Management of Blunt Traumatic Pseudoaneurysms of the Internal Carotid Artery: The Harborview Algorithm Based Off a 10-Year Experience. Ann Surg. 2015; 263(4):821-6. DOI: 10.1097/SLA.0000000000001158. View

15.

Pan L, Liu P, Yang M, Ma L, Li J, Chen G . Application of stent-graft is the optimal therapy for traumatic internal carotid artery pseudoaneurysms. Int J Clin Exp Med. 2015; 8(6):9362-7. PMC: 4538151. View

16.

Zhu D, Yan Y, Zhao P, Duan G, Zhao R, Liu J . Safety and Efficacy of Flow Diverter Treatment for Blood Blister-Like Aneurysm: A Systematic Review and Meta-Analysis. World Neurosurg. 2018; 118:e79-e86. DOI: 10.1016/j.wneu.2018.06.123. View

17.

Tan J, Song R, Luo S, Fu W, Su J, He Z . Willis covered stent treatment for blood blister-like aneurysm: A meta-analysis of efficacy and safety. Front Neurol. 2023; 13:1101625. PMC: 9990463. DOI: 10.3389/fneur.2022.1101625. View

18.

Wang W, Li M, Li Y, Gu B, Wang J, Zhang P . Treatment of traumatic internal carotid artery pseudoaneurysms with the Willis covered stent: a prospective study. J Trauma. 2011; 70(4):816-22. DOI: 10.1097/TA.0b013e3181f892af. View

19.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

20.

Liu L, Zhang C, Lin S, Wu C, Wang T, Zhou L . Application of the Willis Covered Stent in the Treatment of Ophthalmic Artery Segment Aneurysms: A Single-Center Experience. World Neurosurg. 2019; 122:e546-e552. DOI: 10.1016/j.wneu.2018.10.098. View