Meta Aanalysis Of Risk Factors Related To Recurrence After Endovascular Treatment Of Intracranial Aneurysm

Objective:Intracranial aneurysm,a serious cerebrovascular disease,has a higher risk of rupture and causes hemorrhage in the subarachnoid with high disability and mortality rate.Nowdays,EVT of intracranial aneurysms is being mature,while the limition of this techniquet is the high aneurysm recurrence and rebleeding rate after endovascular embolization treatment.In recent years,there have been some retrospective studies on the factors related to aneurysms recurrence after endovascular embolization at home and abroad.However,there are still some differences in the results of studies.Therefore,it i5 neeessary to extract research data from different databases for further comprehensive analysis.By taking the recurrent and non-recurrent groups in related literatures as the research objects to make a meta-analysis,this thesis aims to build an evaluation form according to the risk factors identified by the analysis to predicte the risk of recurrence after treatment so as to supply instructions to the individual therapyMethods:In accordance with strict inclusion and exclusion criteria,the literatures,covering a period from January,2008 to December,2018,were searched by means of manual searches and electronic searches which is based on the key.Arord and subject retrieval from China Biology Medicine disc,China National Knowledge InfrastructUre,Wanfang Data Knowledge Service Platform,Cochrane Library,The Excerpta Medica Database and National Center for Biotechnology Information databases.And then Newcastle-Ottawa Scale was utilized to evaluated the quality of literatures.A meta-analysis was conducted using RevMan5.3 to analyze data extracted from recurrent group and non-recurrent groups.The result of two categorical variables were represented by Odds ratio and 95%confidence interval.The Z test were used to evaluate the stastics combined by Odds ratio and 95%confidence interval.The test showed P<0.05,and it were statistically significant.Forest plot was drawn according to the adta analysis,and the evaluation table was formed.Results:After exclusion of duplicated reference,a total of 530 references were indentified through electroninc database searches and manual searches.After applying inclusion and exclusion criteria,11 relevant refemce(including 4 Chinese articles,7 English articles)were include for the analysis,and all of them are retrospective studies.In these studies,1000 recurrent cases and 4246 non-recurrent cases.There were 11 factors that were involved in the analysis,including gender,age,past hypertension history,past smoking history,ruptured aneurysm,the location of intracranial aneurysm,the relationship between intracranial aneurysm and its parent artery,the size of intracranial aneurysm,the neck size of aneurysm,stent placement and the degree of embolization.The result of Meta analysis:there are differences in the recurrent rate of those factors,and the differences are stasticly significant,including ruptured anrurysm(OR=1.76,95%CI[1.38,2.24],P<0.00001),large aneurysm(OR=0.23,95%CI[0.18,0.29],P<0.00001),wide-neck aneurysm(OR=2.90,95%CI[1.71,4.92],P<0.0001),simple embolization aneurysm(OR=2.37,95%CI[1.89,2.97],P<0.00001)and incomplete Embolization aneurysms(OR=3.32,95%CI[2.37,4.65],P<0.00001);and there are no statistical significance in those factors,including gender(OR=0.98,95%CI[0.80,1.19],P=0.83),age(OR=0.50,95%CI[0.21,1.17],P=0.11),past hypertension history(OR=1.10,95%CI[0.89,1.36],P=0.40),past smoking history(OR=1.11,95%CI[0.84,1.48],P=0.45),anterior and posterior circulation aneurysm(OR=0.83,95%CI[0.46,1.51],P=0.54),anterior circulation traffic department and non-traffic department of the anterior circulation(OR=0.99,95%CI[0.68,1.43],P=0.95),the relationship between intracranial aneurysm and its parent artery(OR=1.13,95%CI[0.87,1.47],P=0.37).Conclusion:Intracranial aneurysm recurrence after endovascular embolization treatment is related to ruptured aneurysm,large aneurysm,wide-necked aneurysm,simple embolization of aneuiysm and incomplete embolization of aneurysm,which are related risk factors for recurrence.And the relationship between aneurysm recurrence and the flowing factor remain unclear,including sex,age,history of hypertension,smoking history,location of aneurysms,and relationship with parent artery.The results of this study will predict the risk of aneurysm recurrence,guide clinical individualized treatment and improve the prognosis of patients.