Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy and Article Selection
2.2. Outcomes
2.3. Data Collection
2.4. Bias Evaluation
2.5. Statistics
3. Results
3.1. Study Population and Patient Characteristics
3.2. Primary and Secondary Outcomes
3.3. Quality of Evidence
3.4. Prediction Model
4. Discussion
4.1. Prediction Model
4.2. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
Appendix A. Search Syntaxes
PubMed
Embase
Appendix B. Data Collection—Baseline Characteristics and Outcome
Registered Baseline Items
Registered Outcome Parameters
References
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Pooled Variables | Number (%) | Number of Articles |
---|---|---|
Total population | ||
N. eligible patients | 357 | 26 |
N. eligible aneurysms | 368 | 26 |
Proportion of unfavorable HH/WFNS grades at presentation | 96/348 (28) | 25 a |
26 | ||
Aneurysm type | ||
Blood blister-like | 161 (44) | |
Saccular | 81 (22) | |
Fusiform | 32 (9) | |
Dissecting | 90 (24) | |
Pseudoaneurysm | 3 (1) | |
Mycotic | 1 (0.2) | |
Aneurysms located in posterior circulation | 235/368 (64) | 26 |
Aneurysms additionally coiled | 56/307 (18) | 24 b |
Favorable clinical outcome (mRS 0–2, GOS 4–5) | 243/338 (72) | 25 c |
Complete occlusion | 253/290 (87) | 25 d |
Complications | 87/356 (24) | 26 |
Leading to a permanent neurological deficit in N patients | 32/265 (12) | 21 e |
Rebleeding | 11/368 (3) | 26 |
All-cause mortality | 50/357 (14) | 26 |
Predictor Variable | OR (95% CI) | p-Value |
---|---|---|
Unfavorable presentation (WFNS and HH 4–5) | 0.156 (0.064–0.382) | <0.01 |
Saccular aneurysm | 2.142 (0.781–5.870) | 0.14 |
Aneurysm location (posterior circulation) | 0.763 (0.331–1.763) | 0.53 |
Aneurysm size (in mm) | 0.883 (0.826–0.944) | <0.01 |
Treatment delay (in days) | 1.053 (0.945–1.174) | 0.35 |
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ten Brinck, M.F.M.; Shimanskaya, V.E.; Aquarius, R.; Bartels, R.H.M.A.; Meijer, F.J.A.; Koopmans, P.C.; de Jong, G.; Wakhloo, A.K.; de Vries, J.; Boogaarts, H.D. Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW). Brain Sci. 2022, 12, 394. https://doi.org/10.3390/brainsci12030394
ten Brinck MFM, Shimanskaya VE, Aquarius R, Bartels RHMA, Meijer FJA, Koopmans PC, de Jong G, Wakhloo AK, de Vries J, Boogaarts HD. Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW). Brain Sciences. 2022; 12(3):394. https://doi.org/10.3390/brainsci12030394
Chicago/Turabian Styleten Brinck, Michelle F. M., Viktoria E. Shimanskaya, René Aquarius, Ronald H. M. A. Bartels, Frederick J. A. Meijer, Petra C. Koopmans, Guido de Jong, Ajay K. Wakhloo, Joost de Vries, and Hieronymus D. Boogaarts. 2022. "Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW)" Brain Sciences 12, no. 3: 394. https://doi.org/10.3390/brainsci12030394