TY - JOUR
T1 - Safety and efficacy of treatment strategies for posterior inferior cerebellar artery aneurysms
T2 - a systematic review and meta-analysis
AU - Petr, Ondra
AU - Sejkorová, Alena
AU - Bradáč, Ondřej
AU - Brinjikji, Waleed
AU - Lanzino, Giuseppe
N1 - Publisher Copyright:
© 2016, Springer-Verlag Wien.
PY - 2016/12/1
Y1 - 2016/12/1
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.
KW - Aneurysm
KW - Endovascular treatment
KW - Meta-analysis
KW - Microsurgery
KW - PICA
UR - http://www.scopus.com/inward/record.url?scp=84990903024&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84990903024&partnerID=8YFLogxK
U2 - 10.1007/s00701-016-2965-3
DO - 10.1007/s00701-016-2965-3
M3 - Review article
C2 - 27718027
AN - SCOPUS:84990903024
SN - 0001-6268
VL - 158
SP - 2415
EP - 2428
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
IS - 12
ER -