Abstract
Background and purpose: Coiling and flow diversion are established endovascular techniques for treatment
of cavernous carotid aneurysms (CCAs). We performed a systematic review of published
series on endovascular treatment of CCAs in order to assess the efficacy and safety
between coiling and flow diversion. Methods: We conducted a computerized search of PubMed, MEDLINE, and Web of Science electronic
databases for reports on endovascular treatment of CCAs from 1990 to 2019. Comparisons
were made in complete occlusion rate, improvement of symptoms rate and intraoperative
complication rate between coiling and flow diversion. Results: Fourteen studies with 736 patients were included in this systematic review. Five
hundred ninety-4 patients underwent coiling, 142 patients underwent flow diversion.
The complete occlusion rate in the coiling group was significantly lower than that
in the flow division group (odds ratio .37, 95%CI .16-.83, P < .00001), a forest plot did not reveal any significant differences in the improvement
of symptoms rate or intraoperative complication rate following coiling and flow diversion.
Complete occlusion rate was significantly lower in the coiling group (53%, 95%CI .40-.67)
compared with the flow diversion group (74%, 95%CI .55-.94). Improvement of symptoms
was significantly lower in the coiling group (54%, 95%CI .46-.63) compared with the
flow diversion group (92%, 95%CI .85-.99). Coiling group had lower intraoperative
complication rate (9%, 95%CI .06-.12) compared with flow division group (36%, 95%CI
.25–.47). Conclusions: Compared with coiling, the use of flow diversion for the treatment of CCAs may increase
complete occlusion rate, and improvement of symptoms rate, but it also raised intraoperative
complication rate. Due to the lack of high quality control research, further randomized
controlled trials are needed to verify our conclusions.
Keywords
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References
- Endovascular treatment of aneurysms in the cavernous sinus: a systematic review on balloon occlusion of the parent vessel and embolization with coils.Stroke. 2002; 33: 313-318
- Endovascular coiling versus parent artery occlusion for treatment of cavernous carotid aneurysms: a meta-analysis.J Neurointerv Surg. 2014; 7: 252-255
- Presentation, natural history, and management of carotid cavernous aneurysms.Neurosurgery. 2005; 57: 850-857
- Long-term clinical and angiographic outcomes following pipeline embolization device treatment of complex internal carotid artery aneurysms: five-year results of the pipeline for uncoilable or failed aneurysms trial.Neurosurgery. 2017; 80: 40-48
- Presentation, natural history, and management of carotid cavernous aneurysms.Neurosurgery. 2005; 57: 850-857
- Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms.Stroke. 2013; 44: 2150-2154
- Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: a literature review.Am J Neuroradiol. 2008; 29: 1777-1781
- Cavernous internal carotid artery aneurysms treated with electrolyticall detachable coils.J Neuro Ophthalmol. 1997; 17: 231-239
- Efficacy of endovascular surgery for unruptured internal carotid artery aneurysms presenting with cranial nerve symptoms.Interv Neuroradiol. 2007; 1: 164-169
- Endosaccular treatment of 113 cavernous carotid artery aneurysms.J NeuroInterv Surg. 2010; 2: 359-362
- Endovascular treatment of cavernous sinus aneurysms.Am J Neuroradiol. 2012; 33: 323-326
- Improvement in visual symptomatology after endovascular treatment of cavernous carotid aneurysms: a multicenter study.J Vasc Interv Neurol. 2013; 6: 15-21
- Endovascular.treatment of carotid cavernous aneurysms: complications, outcomes and comparison of interventional strategies.J Clin Neurosci. 2014; 21: 40-46
- Stent-assisted coil embolization for cavernous carotid artery aneurysms.Neurologia medico-chirurgica. 2014; 54: 126-132
- Clinical and angiographic outcome of endovascular and conservative treatment for giant cavernous carotid artery aneurysms.Interv Neuroradiol. 2014; 20: 29-37
- Treatment of cavernous sinus aneurysms with flow diversion: results in 44 patients.Am J Neuroradiol. 2014; 35: 948-951
- Flow diversion versus conventional treatment for carotid cavernous aneurysms.Stroke. 2014; 45: 2656-2661
- Innovations in endovascular treatment strategies for large carotid cavernous aneurysms—the safety and efficacy of a flow diverter.J Stroke Cerebrovasc Dis. 2016; 26: 1071-1080
- Endovascular treatment of 147 cases of cavernous carotid aneurysms: a single-center experience.J Stroke Cerebrovasc Dis. 2016; 25: 1929-1935
- Usefulness of the pipeline embolic device for large and giant carotid cavernous aneurysms.Neurointervention. 2017; 12: 83-90
- Endovascular treatment of carotid-cavernous vascular lesions.Arquivos de Neuro-Psiquiatria. 2017; 44: 046-053
- Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms.Stroke. 2013; 44: 2150-2154
- Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial.Radiology. 2013; 267: 858-868
- Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis.Stroke J Cereb. Circ. 2013; 44: 442-447
- The effect of stent porosity and strut shape on saccular aneurysm and its numerical analysis with lattice Boltzmann method.Ann Biomed Eng. 2010; 38: 2274-2292
- Cavernous carotid aneurysms: to treat or not to treat?.Neurosurgical FOCUS. 2009; 26: 4-10
- Curative cerebrovascular reconstruction with the Pipeline embolization device: the emergence of defnitive endovascular therapy for intracranial aneurysms.J Neurointerv Surg. 2009; 1: 56-65
- Long-term clinical and angiographic outcomes following pipeline embolization device treatment of complex internal carotid artery aneurysms: five-year results of the pipeline for uncoilable or failed aneurysms trial.Neurosurgery. 2017; 80: 40-48
- The pipeline embolization device for the intracranial treatment of aneurysms trial.AJNR Am J Neuroradiol. 2011; 32: 34-40
Article info
Publication history
Published online: April 15, 2020
Accepted:
March 4,
2020
Received in revised form:
March 4,
2020
Received:
January 8,
2020
Footnotes
Funding: The authors have not declared a specifc grant for this research from any funding agency in the public, commercial or not-for-proft sectors.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104808
Copyright
© 2020 Elsevier Inc. All rights reserved.
