Artikel
Safety and Efficacy of Surgical and Endovascular Treatment for Distal Anterior Cerebral Artery Aneurysms: a Systematic Review and Meta-analysis
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Autoren
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Ondra Petr
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
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Lucie Coufalová
- Department of Neurosurgery, 1. Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
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Ondřej Bradáč
- Department of Neurosurgery, 1. Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
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Berndhard Glodny
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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Vladimír Beneš
- Department of Neurosurgery, 1. Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
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Rafael Rehwald
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
Text
Objective: Aneurysms of the distal anterior cerebral artery (DACA) are rare, representing between 1% and 9% of all intracranial aneurysms. The best treatment strategy for these aneurysms continue to be debated. We conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies of DACA-aneurysms.
Methods: A systematic search of Medline, EMBASE, Scopus and Web of Science was done for studies published from 01/2000 to 08/2015. We included studies describing treatment of DACA-aneurysms with ³ 10 patients. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality and stroke rates, aneurysm recurrence/rebleed, and long-term neurological morbidity/mortality.
Results: 30 studies with 1329 DACA-aneurysms were included. Complete occlusion was 95% (95%CI=91.0%-97.0%) in the surgical group and 68% 95%CI=56.0%-78.0%) in the endovascular group (P<0.0001). Aneurysm recurrence occurred in 3% (95%CI=2.0%-4.0%) after surgery and in 19.1% (95%CI=12.0%-27.0%) after endovascular treatment (P<0.0001). Overall neurological morbidity and mortality were 15% (95%CI=11.0%-21.0%) and 9% (95%CI=7.0%-11.0%) after surgery and 14% (95%CI=10.0%-19.0%) (P=0.725) and 7% (95%CI=5.0%-10.0%) (P=0.422) after endovascular treatment, respectively. Overall long-term favorable neurological outcome was 80% and was equal in both groups (80%; 95%CI=73.0%-85.0% in the surgical group and 80%; 95%CI=72.0%-87.0% in the endovascular group) (P=0.892).
Conclusion: Our meta-analysis demonstrated that both treatment modalities are technically feasible and effective with sufficient long-term aneurysm occlusion and acceptable recurrence/rebleed rates. Surgical treatment is associated with superior angiographic outcomes including significantly lower postoperative aneurysm rebleed rates. There were no substantial differences in procedure-related morbidity and mortality. These findings should be considered when deciding the best therapeutic strategy for treatment of DACA-aneurysms. However, the final decision-making should be performed on a selective, case-by-case basis in order to maximize patient benefits and limit the risk of periprocedural complications.
