Safety and efficacy of endovascular treatment for intracranial infectious aneurysms: A systematic review and meta-analysis

Ondra Petr, Waleed Brinjikji, Anthony M. Burrows, Harry Cloft, David F Kallmes, Giuseppe Lanzino

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Introduction: Intracranial infectious aneurysms (IIAs), or mycotic aneurysms are rare, representing between 0.7% and 5.4% of all intracranial aneurysms. To clarify the safety and efficacy of endovascular treatment of IIAs, we conducted a systematic review of the literature analyzing periprocedural and long-term clinical and angiographic outcomes. Methods: A comprehensive review of the literature for studies with ≥. 3 patients related to endovascular treatment of IIAs published through September 2015 was performed. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, iatrogenic rupture, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurological outcome. Results: We included 11 non-comparative studies with 86 target IIAs. Complete occlusion rates were 95.3% (95% CI = 91.2-99.4%). Recurrence occurred in 7.9% (95% CI = 2.7-13.0%). Rebleeding occurred in 5.8% (95% CI = 1.4-10.3%) of patients. Procedure-related morbidity was 12.6% (95% CI = 6.1-19.2%) and procedure-related mortality was 6.1% (95% CI = 1.5-10.8%). Long-term good neurological outcome was 68.0% (95% CI = 55.1-80.9%). Conclusion: Our meta-analysis demonstrated that endovascular treatment is technically feasible and effective with high rates of IIA occlusion. Despite the comorbidities of patients, endovascular approach was associated with acceptable rates of procedure-related morbidity and satisfactory rates of overall good neurological outcome.

Original languageEnglish (US)
JournalJournal of Neuroradiology
DOIs
StateAccepted/In press - 2016

Fingerprint

Intracranial Aneurysm
Meta-Analysis
Safety
Morbidity
Mortality
Infected Aneurysm
Recurrence
Aneurysm
Comorbidity
Rupture
Stroke
Therapeutics

Keywords

  • Endovascular treatment
  • Intracranial infectious aneurysms (IIAs)
  • Meta-analysis
  • Mycotic

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Safety and efficacy of endovascular treatment for intracranial infectious aneurysms : A systematic review and meta-analysis. / Petr, Ondra; Brinjikji, Waleed; Burrows, Anthony M.; Cloft, Harry; Kallmes, David F; Lanzino, Giuseppe.

In: Journal of Neuroradiology, 2016.

Research output: Contribution to journalArticle

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abstract = "Introduction: Intracranial infectious aneurysms (IIAs), or mycotic aneurysms are rare, representing between 0.7{\%} and 5.4{\%} of all intracranial aneurysms. To clarify the safety and efficacy of endovascular treatment of IIAs, we conducted a systematic review of the literature analyzing periprocedural and long-term clinical and angiographic outcomes. Methods: A comprehensive review of the literature for studies with ≥. 3 patients related to endovascular treatment of IIAs published through September 2015 was performed. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, iatrogenic rupture, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurological outcome. Results: We included 11 non-comparative studies with 86 target IIAs. Complete occlusion rates were 95.3{\%} (95{\%} CI = 91.2-99.4{\%}). Recurrence occurred in 7.9{\%} (95{\%} CI = 2.7-13.0{\%}). Rebleeding occurred in 5.8{\%} (95{\%} CI = 1.4-10.3{\%}) of patients. Procedure-related morbidity was 12.6{\%} (95{\%} CI = 6.1-19.2{\%}) and procedure-related mortality was 6.1{\%} (95{\%} CI = 1.5-10.8{\%}). Long-term good neurological outcome was 68.0{\%} (95{\%} CI = 55.1-80.9{\%}). Conclusion: Our meta-analysis demonstrated that endovascular treatment is technically feasible and effective with high rates of IIA occlusion. Despite the comorbidities of patients, endovascular approach was associated with acceptable rates of procedure-related morbidity and satisfactory rates of overall good neurological outcome.",
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T2 - A systematic review and meta-analysis

AU - Petr, Ondra

AU - Brinjikji, Waleed

AU - Burrows, Anthony M.

AU - Cloft, Harry

AU - Kallmes, David F

AU - Lanzino, Giuseppe

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N2 - Introduction: Intracranial infectious aneurysms (IIAs), or mycotic aneurysms are rare, representing between 0.7% and 5.4% of all intracranial aneurysms. To clarify the safety and efficacy of endovascular treatment of IIAs, we conducted a systematic review of the literature analyzing periprocedural and long-term clinical and angiographic outcomes. Methods: A comprehensive review of the literature for studies with ≥. 3 patients related to endovascular treatment of IIAs published through September 2015 was performed. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, iatrogenic rupture, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurological outcome. Results: We included 11 non-comparative studies with 86 target IIAs. Complete occlusion rates were 95.3% (95% CI = 91.2-99.4%). Recurrence occurred in 7.9% (95% CI = 2.7-13.0%). Rebleeding occurred in 5.8% (95% CI = 1.4-10.3%) of patients. Procedure-related morbidity was 12.6% (95% CI = 6.1-19.2%) and procedure-related mortality was 6.1% (95% CI = 1.5-10.8%). Long-term good neurological outcome was 68.0% (95% CI = 55.1-80.9%). Conclusion: Our meta-analysis demonstrated that endovascular treatment is technically feasible and effective with high rates of IIA occlusion. Despite the comorbidities of patients, endovascular approach was associated with acceptable rates of procedure-related morbidity and satisfactory rates of overall good neurological outcome.

AB - Introduction: Intracranial infectious aneurysms (IIAs), or mycotic aneurysms are rare, representing between 0.7% and 5.4% of all intracranial aneurysms. To clarify the safety and efficacy of endovascular treatment of IIAs, we conducted a systematic review of the literature analyzing periprocedural and long-term clinical and angiographic outcomes. Methods: A comprehensive review of the literature for studies with ≥. 3 patients related to endovascular treatment of IIAs published through September 2015 was performed. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, iatrogenic rupture, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurological outcome. Results: We included 11 non-comparative studies with 86 target IIAs. Complete occlusion rates were 95.3% (95% CI = 91.2-99.4%). Recurrence occurred in 7.9% (95% CI = 2.7-13.0%). Rebleeding occurred in 5.8% (95% CI = 1.4-10.3%) of patients. Procedure-related morbidity was 12.6% (95% CI = 6.1-19.2%) and procedure-related mortality was 6.1% (95% CI = 1.5-10.8%). Long-term good neurological outcome was 68.0% (95% CI = 55.1-80.9%). Conclusion: Our meta-analysis demonstrated that endovascular treatment is technically feasible and effective with high rates of IIA occlusion. Despite the comorbidities of patients, endovascular approach was associated with acceptable rates of procedure-related morbidity and satisfactory rates of overall good neurological outcome.

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KW - Intracranial infectious aneurysms (IIAs)

KW - Meta-analysis

KW - Mycotic

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