Safety and efficacy of treatment strategies for posterior inferior cerebellar artery aneurysms: a systematic review and meta-analysis

Ondra Petr, Alena Sejkorová, Ondřej Bradáč, Waleed Brinjikji, Giuseppe Lanzino

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

Introduction: We conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies for PICA aneurysms. Methods: A systematic search of Medline, EMBASE, Scopus, and Web of Science was done for studies published through November 2015. We included studies that described treatment of PICA aneurysms with ≥10 patients. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality, stroke rates, aneurysm recurrence/rebleed, CN palsies rates, and long-term neurological morbidity/mortality. Results: We included 29 studies with 796 PICA aneurysms. When considering all ruptured PICA aneurysms, complete occlusion rates were 97.1 % (95 % CI = 94.5–99.0 %) in the surgical group and 84.3 % (95 % CI = 73.8–92.6 %) in the endovascular group. Aneurysm recurrence occurred in 1.4 % (95 % CI = 0.3–3.3 %) after surgery and in 6.9 % (95 % CI = 3.6–10.9 %) after endovascular treatment. Overall neurological morbidity and mortality were 14.4 % (95 % CI = 8.7–21.2 %) and 9.8 % (95 % CI = 5.8–14.8 %) after surgery and 15.1 % (95 % CI = 10.5–20.2 %) and 17.1 % (95 % CI = 11.5–23.7 %) after endovascular treatment, respectively. When considering all unruptured PICA aneurysms, complete occlusion rates were 92.9 % (95 % CI = 79.5–100 %) in the surgical group and 75.7 % (95 % CI = 45.4–97.1 %) in the endovascular group. Overall long-term good neurological outcome rates were 91.5 % (95 % CI = 74.4–100 %) in the surgical series and 93.3 % (95 % CI = 82.7–99.5 %) in the endovascular group. Conclusions: Our meta-analysis demonstrated that both treatment modalities are technically feasible with high rates of technical success and effective with sufficient long-term aneurysm occlusion rates. Our data suggest that surgery is associated with superior angiographic outcomes. While endovascular therapy could be a reasonable first-line treatment option for proximal PICA aneurysms, surgery remains a highly effective first-line choice for distal PICA aneurysms. These findings should be considered when deciding the best therapeutic strategy.

Original languageEnglish (US)
Pages (from-to)2415-2428
Number of pages14
JournalActa Neurochirurgica
Volume158
Issue number12
DOIs
StatePublished - Dec 1 2016

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Aneurysm
Meta-Analysis
Arteries
Safety
Morbidity
Mortality
Therapeutics
Recurrence
Ruptured Aneurysm
Paralysis
Stroke

Keywords

  • Aneurysm
  • Endovascular treatment
  • Meta-analysis
  • Microsurgery
  • PICA

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Safety and efficacy of treatment strategies for posterior inferior cerebellar artery aneurysms : a systematic review and meta-analysis. / Petr, Ondra; Sejkorová, Alena; Bradáč, Ondřej; Brinjikji, Waleed; Lanzino, Giuseppe.

In: Acta Neurochirurgica, Vol. 158, No. 12, 01.12.2016, p. 2415-2428.

Research output: Contribution to journalReview article

Petr, Ondra ; Sejkorová, Alena ; Bradáč, Ondřej ; Brinjikji, Waleed ; Lanzino, Giuseppe. / Safety and efficacy of treatment strategies for posterior inferior cerebellar artery aneurysms : a systematic review and meta-analysis. In: Acta Neurochirurgica. 2016 ; Vol. 158, No. 12. pp. 2415-2428.
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abstract = "Introduction: We conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies for PICA aneurysms. Methods: A systematic search of Medline, EMBASE, Scopus, and Web of Science was done for studies published through November 2015. We included studies that described treatment of PICA aneurysms with ≥10 patients. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality, stroke rates, aneurysm recurrence/rebleed, CN palsies rates, and long-term neurological morbidity/mortality. Results: We included 29 studies with 796 PICA aneurysms. When considering all ruptured PICA aneurysms, complete occlusion rates were 97.1 {\%} (95 {\%} CI = 94.5–99.0 {\%}) in the surgical group and 84.3 {\%} (95 {\%} CI = 73.8–92.6 {\%}) in the endovascular group. Aneurysm recurrence occurred in 1.4 {\%} (95 {\%} CI = 0.3–3.3 {\%}) after surgery and in 6.9 {\%} (95 {\%} CI = 3.6–10.9 {\%}) after endovascular treatment. Overall neurological morbidity and mortality were 14.4 {\%} (95 {\%} CI = 8.7–21.2 {\%}) and 9.8 {\%} (95 {\%} CI = 5.8–14.8 {\%}) after surgery and 15.1 {\%} (95 {\%} CI = 10.5–20.2 {\%}) and 17.1 {\%} (95 {\%} CI = 11.5–23.7 {\%}) after endovascular treatment, respectively. When considering all unruptured PICA aneurysms, complete occlusion rates were 92.9 {\%} (95 {\%} CI = 79.5–100 {\%}) in the surgical group and 75.7 {\%} (95 {\%} CI = 45.4–97.1 {\%}) in the endovascular group. Overall long-term good neurological outcome rates were 91.5 {\%} (95 {\%} CI = 74.4–100 {\%}) in the surgical series and 93.3 {\%} (95 {\%} CI = 82.7–99.5 {\%}) in the endovascular group. Conclusions: Our meta-analysis demonstrated that both treatment modalities are technically feasible with high rates of technical success and effective with sufficient long-term aneurysm occlusion rates. Our data suggest that surgery is associated with superior angiographic outcomes. While endovascular therapy could be a reasonable first-line treatment option for proximal PICA aneurysms, surgery remains a highly effective first-line choice for distal PICA aneurysms. These findings should be considered when deciding the best therapeutic strategy.",
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T1 - Safety and efficacy of treatment strategies for posterior inferior cerebellar artery aneurysms

T2 - a systematic review and meta-analysis

AU - Petr, Ondra

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AU - Bradáč, Ondřej

AU - Brinjikji, Waleed

AU - Lanzino, Giuseppe

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N2 - Introduction: We conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies for PICA aneurysms. Methods: A systematic search of Medline, EMBASE, Scopus, and Web of Science was done for studies published through November 2015. We included studies that described treatment of PICA aneurysms with ≥10 patients. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality, stroke rates, aneurysm recurrence/rebleed, CN palsies rates, and long-term neurological morbidity/mortality. Results: We included 29 studies with 796 PICA aneurysms. When considering all ruptured PICA aneurysms, complete occlusion rates were 97.1 % (95 % CI = 94.5–99.0 %) in the surgical group and 84.3 % (95 % CI = 73.8–92.6 %) in the endovascular group. Aneurysm recurrence occurred in 1.4 % (95 % CI = 0.3–3.3 %) after surgery and in 6.9 % (95 % CI = 3.6–10.9 %) after endovascular treatment. Overall neurological morbidity and mortality were 14.4 % (95 % CI = 8.7–21.2 %) and 9.8 % (95 % CI = 5.8–14.8 %) after surgery and 15.1 % (95 % CI = 10.5–20.2 %) and 17.1 % (95 % CI = 11.5–23.7 %) after endovascular treatment, respectively. When considering all unruptured PICA aneurysms, complete occlusion rates were 92.9 % (95 % CI = 79.5–100 %) in the surgical group and 75.7 % (95 % CI = 45.4–97.1 %) in the endovascular group. Overall long-term good neurological outcome rates were 91.5 % (95 % CI = 74.4–100 %) in the surgical series and 93.3 % (95 % CI = 82.7–99.5 %) in the endovascular group. Conclusions: Our meta-analysis demonstrated that both treatment modalities are technically feasible with high rates of technical success and effective with sufficient long-term aneurysm occlusion rates. Our data suggest that surgery is associated with superior angiographic outcomes. While endovascular therapy could be a reasonable first-line treatment option for proximal PICA aneurysms, surgery remains a highly effective first-line choice for distal PICA aneurysms. These findings should be considered when deciding the best therapeutic strategy.

AB - Introduction: We conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies for PICA aneurysms. Methods: A systematic search of Medline, EMBASE, Scopus, and Web of Science was done for studies published through November 2015. We included studies that described treatment of PICA aneurysms with ≥10 patients. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality, stroke rates, aneurysm recurrence/rebleed, CN palsies rates, and long-term neurological morbidity/mortality. Results: We included 29 studies with 796 PICA aneurysms. When considering all ruptured PICA aneurysms, complete occlusion rates were 97.1 % (95 % CI = 94.5–99.0 %) in the surgical group and 84.3 % (95 % CI = 73.8–92.6 %) in the endovascular group. Aneurysm recurrence occurred in 1.4 % (95 % CI = 0.3–3.3 %) after surgery and in 6.9 % (95 % CI = 3.6–10.9 %) after endovascular treatment. Overall neurological morbidity and mortality were 14.4 % (95 % CI = 8.7–21.2 %) and 9.8 % (95 % CI = 5.8–14.8 %) after surgery and 15.1 % (95 % CI = 10.5–20.2 %) and 17.1 % (95 % CI = 11.5–23.7 %) after endovascular treatment, respectively. When considering all unruptured PICA aneurysms, complete occlusion rates were 92.9 % (95 % CI = 79.5–100 %) in the surgical group and 75.7 % (95 % CI = 45.4–97.1 %) in the endovascular group. Overall long-term good neurological outcome rates were 91.5 % (95 % CI = 74.4–100 %) in the surgical series and 93.3 % (95 % CI = 82.7–99.5 %) in the endovascular group. Conclusions: Our meta-analysis demonstrated that both treatment modalities are technically feasible with high rates of technical success and effective with sufficient long-term aneurysm occlusion rates. Our data suggest that surgery is associated with superior angiographic outcomes. While endovascular therapy could be a reasonable first-line treatment option for proximal PICA aneurysms, surgery remains a highly effective first-line choice for distal PICA aneurysms. These findings should be considered when deciding the best therapeutic strategy.

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KW - Endovascular treatment

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KW - Microsurgery

KW - PICA

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