Patency of the supraclinoid internal carotid artery branches after flow diversion treatment. A meta-analysis.

BACKGROUND AND PURPOSE: Placement of flow-diverters across the ostia of major ICA branches carries a risk of arterial occlusion. We determined the rate of occlusion of the supraclinoid ICA branches and the related symptoms, following coverage with flow-diverters. MATERIALS AND METHODS: A systematic search was performed in PubMed, MEDLINE, and EMBASE. We selected studies reporting treatments with flow-diverters in which the device was placed across the ostium of the OphtA, PcomA, or AchorA. Random-effects meta-analysis was used to pool the following outcomes: rate of arterial occlusion, diminished flow, incidence of related symptoms, factors associated with arterial occlusion. RESULT: Twenty-one studies evaluating 1152 supraclinoid ICA branches were included in the meta-analysis. The incidence of OphtA occlusion and associated symptoms was 5.9% (95 CI% = 3.1-8.6%) (incidence rate = 6% per patient-year), and 0.8% (95% CI = 0.1-1.4%) (incidence rate = 0.8% per patient-year), respectively. Although asymptomatic in all cases, PcomA showed a higher occlusion rate (20.7%, 95% CI = 8.9-32.4%) (incidence rate = 19.5% per patient-year). AchorA was occluded in 1% (95% CI = 0.3-2.4%) of cases, with approximately 1% (95% CI = 0.4-2.3%) of transient neurological symptoms (incidence rate = 0.96% per patient-year). There was a trend toward higher odds of arterial patency among arteries arising from the aneurysm (OR = 2.94, P = 0.06). Demographic factors and multiple stents were not associated with higher risk of arterial impairment. Adequate collateral circulation was reported in 94.5% of patients with arterial occlusion. CONCLUSIONS: During aneurysm treatment, the ostium of the supraclinoid ICA branches can be covered with flow-diverter devices with low rates of neurological symptoms related to arterial occlusion.

Addressing transboundary conservation challenges through marine spatial prioritization.

The Adriatic and Ionian Region is an important area for both strategic maritime development and biodiversity conservation in the European Union (EU). However, given that both EU and non-EU countries border the sea, multiple legal and regulatory frameworks operate at different scales, which can hinder the coordinated long-term sustainable development of the region. Transboundary marine spatial planning can help overcome these challenges by building consensus on planning objectives and making the trade-offs between biodiversity conservation and its influence on economically important sectors more explicit. We address this challenge by developing and testing 4 spatial prioritization strategies with the decision-support tool Marxan, which meets targets for biodiversity conservation while minimizing impacts to users. We evaluated these strategies in terms of how priority areas shift under different scales of target setting (e.g., regional vs. country level). We also examined the trade-off between cost-efficiency and how equally solutions represent countries and maritime industries (n = 14) operating in the region with the protection-equality metric. We found negligible differences in where priority conservation areas were located when we set targets for biodiversity at the regional versus country scale. Conversely, the prospective impacts on industries, when considered as costs to be minimized, were highly divergent across scenarios and biased the placement of protection toward industries located in isolation or where there were few other industries. We recommend underpinning future marine spatial planning efforts in the region through identification of areas of national significance, transboundary areas requiring cooperation between countries, and areas where impacts on maritime industries require careful consideration of the trade-off between biodiversity conservation and socioeconomic objectives.