Surgery or Endovascular Treatment in Patients with Anterior Communicating Artery Aneurysm: A Systematic Review and Meta-Analysis
Although randomized controlled trials have compared surgery versus endovascular treatment for intracranial aneurysms, the literature is sparse in terms of subgroup analysis for anterior communicating artery (ACoA) aneurysm management. This systematic review and meta-analysis sought to compare surgic...
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| Veröffentlicht in: | World neurosurgery 2023-07, Vol.175, p.31-44 |
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| creator | Sattari, Shahab Aldin Shahbandi, Ataollah Lee, Ryan P. Feghali, James Rincon-Torroella, Jordina Yang, Wuyang Abdulrahim, Mostafa Ahmadi, Sina So, Raymond J. Hung, Alice Caplan, Justin M. Gonzalez, Fernando Tamargo, Rafael J. Huang, Judy Xu, Risheng |
| description | Although randomized controlled trials have compared surgery versus endovascular treatment for intracranial aneurysms, the literature is sparse in terms of subgroup analysis for anterior communicating artery (ACoA) aneurysm management. This systematic review and meta-analysis sought to compare surgical versus endovascular treatment for ACoA aneurysms.
Medline, PubMed, and Embase were searched from inception to December 12, 2022. Primary outcomes were post-treatment modified Rankin Scale (mRS) >2 and mortality. Secondary outcomes were aneurysm obliteration, retreatment and recurrence, rebleeding, technical failure, vessel rupture, aneurysmal subarachnoid hemorrhage-related hydrocephalus, symptomatic vasospasm, and stroke.
Eighteen studies yielded 2368 patients, from which 1196 (50.5%) and 1172 (49.4%) patients underwent surgery and endovascular treatment, respectively. The odds ratio (OR) of mortality was similar in total (OR = 0.92 [0.63–1.37], P = 0.69), ruptured (OR = 0.92 [0.62–1.36], P = 0.66), and unruptured cohorts (OR = 1.58 [0.06–39.60], P = 0.78). The OR of mRS > 2 was similar in total (OR = 0.75 [0.50–1.13], P = 0.17), ruptured (OR = 0.77 [0.49–1.20], P = 0.25), and unruptured cohorts (OR = 0.64 [0.21–1.96], P = 0.44). The OR of obliteration was higher with surgery in the total (OR = 2.52 [1.49–4.27], P = 0.0008) and ruptured cohorts (OR = 2.61 [1.33–5.10], P = 0.005) and unruptured group (OR = 3.46 [1.30–9.20], P = 0.01). The OR of retreatment was lower with surgery in the total (OR = 0.37 [0.17–0.76], P = 0.007) and ruptured cohorts (OR = 0.31 [0.11–0.89], P = 0.03), thought it was similar in the unruptured group (OR = 0.51 [0.08–3.03], P = 0.46). The OR of recurrence was lower with surgery in the total (OR = 0.22 [0.10, 0.47], P = 0.0001), ruptured (OR = 0.16 [0.03, 0.90], P = 0.04), and mixed (un) ruptured cohorts (OR = 0.22 [0.09–0.53], P = 0.0009). The OR of rebleeding in ruptured group was similar (OR = 0.66 [0.29–1.52], P = 0.33). The ORs of other outcomes were similar.
ACoA aneurysms may be safely treated with either surgery or endovascular treatment, although microsurgical clipping demonstrates higher obliteration rates and lower rates of retreatment and recurrence. |
| doi_str_mv | 10.1016/j.wneu.2023.03.111 |
| format | Article |
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Medline, PubMed, and Embase were searched from inception to December 12, 2022. Primary outcomes were post-treatment modified Rankin Scale (mRS) >2 and mortality. Secondary outcomes were aneurysm obliteration, retreatment and recurrence, rebleeding, technical failure, vessel rupture, aneurysmal subarachnoid hemorrhage-related hydrocephalus, symptomatic vasospasm, and stroke.
Eighteen studies yielded 2368 patients, from which 1196 (50.5%) and 1172 (49.4%) patients underwent surgery and endovascular treatment, respectively. The odds ratio (OR) of mortality was similar in total (OR = 0.92 [0.63–1.37], P = 0.69), ruptured (OR = 0.92 [0.62–1.36], P = 0.66), and unruptured cohorts (OR = 1.58 [0.06–39.60], P = 0.78). The OR of mRS > 2 was similar in total (OR = 0.75 [0.50–1.13], P = 0.17), ruptured (OR = 0.77 [0.49–1.20], P = 0.25), and unruptured cohorts (OR = 0.64 [0.21–1.96], P = 0.44). The OR of obliteration was higher with surgery in the total (OR = 2.52 [1.49–4.27], P = 0.0008) and ruptured cohorts (OR = 2.61 [1.33–5.10], P = 0.005) and unruptured group (OR = 3.46 [1.30–9.20], P = 0.01). The OR of retreatment was lower with surgery in the total (OR = 0.37 [0.17–0.76], P = 0.007) and ruptured cohorts (OR = 0.31 [0.11–0.89], P = 0.03), thought it was similar in the unruptured group (OR = 0.51 [0.08–3.03], P = 0.46). The OR of recurrence was lower with surgery in the total (OR = 0.22 [0.10, 0.47], P = 0.0001), ruptured (OR = 0.16 [0.03, 0.90], P = 0.04), and mixed (un) ruptured cohorts (OR = 0.22 [0.09–0.53], P = 0.0009). The OR of rebleeding in ruptured group was similar (OR = 0.66 [0.29–1.52], P = 0.33). The ORs of other outcomes were similar.
ACoA aneurysms may be safely treated with either surgery or endovascular treatment, although microsurgical clipping demonstrates higher obliteration rates and lower rates of retreatment and recurrence.</description><identifier>ISSN: 1878-8750</identifier><identifier>ISSN: 1878-8769</identifier><identifier>EISSN: 1878-8769</identifier><identifier>DOI: 10.1016/j.wneu.2023.03.111</identifier><identifier>PMID: 37011760</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aneurysm ; Aneurysm, Ruptured - therapy ; Anterior communicating artery ; Child ; Clip ; Coil ; Embolization, Therapeutic ; Endovascular ; Endovascular Procedures - adverse effects ; Humans ; Intracranial Aneurysm - surgery ; Meta-analysis ; Retreatment ; Subarachnoid Hemorrhage - therapy ; Surgery ; Treatment Outcome</subject><ispartof>World neurosurgery, 2023-07, Vol.175, p.31-44</ispartof><rights>2023</rights><rights>Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-8d0b6c11bd076bf9ce771488b81d9ce83fa71b8cac8d2c8f435f3bfc72dbd45a3</citedby><cites>FETCH-LOGICAL-c356t-8d0b6c11bd076bf9ce771488b81d9ce83fa71b8cac8d2c8f435f3bfc72dbd45a3</cites><orcidid>0000-0002-4021-3153</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1878875023004357$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37011760$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sattari, Shahab Aldin</creatorcontrib><creatorcontrib>Shahbandi, Ataollah</creatorcontrib><creatorcontrib>Lee, Ryan P.</creatorcontrib><creatorcontrib>Feghali, James</creatorcontrib><creatorcontrib>Rincon-Torroella, Jordina</creatorcontrib><creatorcontrib>Yang, Wuyang</creatorcontrib><creatorcontrib>Abdulrahim, Mostafa</creatorcontrib><creatorcontrib>Ahmadi, Sina</creatorcontrib><creatorcontrib>So, Raymond J.</creatorcontrib><creatorcontrib>Hung, Alice</creatorcontrib><creatorcontrib>Caplan, Justin M.</creatorcontrib><creatorcontrib>Gonzalez, Fernando</creatorcontrib><creatorcontrib>Tamargo, Rafael J.</creatorcontrib><creatorcontrib>Huang, Judy</creatorcontrib><creatorcontrib>Xu, Risheng</creatorcontrib><title>Surgery or Endovascular Treatment in Patients with Anterior Communicating Artery Aneurysm: A Systematic Review and Meta-Analysis</title><title>World neurosurgery</title><addtitle>World Neurosurg</addtitle><description>Although randomized controlled trials have compared surgery versus endovascular treatment for intracranial aneurysms, the literature is sparse in terms of subgroup analysis for anterior communicating artery (ACoA) aneurysm management. This systematic review and meta-analysis sought to compare surgical versus endovascular treatment for ACoA aneurysms.
Medline, PubMed, and Embase were searched from inception to December 12, 2022. Primary outcomes were post-treatment modified Rankin Scale (mRS) >2 and mortality. Secondary outcomes were aneurysm obliteration, retreatment and recurrence, rebleeding, technical failure, vessel rupture, aneurysmal subarachnoid hemorrhage-related hydrocephalus, symptomatic vasospasm, and stroke.
Eighteen studies yielded 2368 patients, from which 1196 (50.5%) and 1172 (49.4%) patients underwent surgery and endovascular treatment, respectively. The odds ratio (OR) of mortality was similar in total (OR = 0.92 [0.63–1.37], P = 0.69), ruptured (OR = 0.92 [0.62–1.36], P = 0.66), and unruptured cohorts (OR = 1.58 [0.06–39.60], P = 0.78). The OR of mRS > 2 was similar in total (OR = 0.75 [0.50–1.13], P = 0.17), ruptured (OR = 0.77 [0.49–1.20], P = 0.25), and unruptured cohorts (OR = 0.64 [0.21–1.96], P = 0.44). The OR of obliteration was higher with surgery in the total (OR = 2.52 [1.49–4.27], P = 0.0008) and ruptured cohorts (OR = 2.61 [1.33–5.10], P = 0.005) and unruptured group (OR = 3.46 [1.30–9.20], P = 0.01). The OR of retreatment was lower with surgery in the total (OR = 0.37 [0.17–0.76], P = 0.007) and ruptured cohorts (OR = 0.31 [0.11–0.89], P = 0.03), thought it was similar in the unruptured group (OR = 0.51 [0.08–3.03], P = 0.46). The OR of recurrence was lower with surgery in the total (OR = 0.22 [0.10, 0.47], P = 0.0001), ruptured (OR = 0.16 [0.03, 0.90], P = 0.04), and mixed (un) ruptured cohorts (OR = 0.22 [0.09–0.53], P = 0.0009). The OR of rebleeding in ruptured group was similar (OR = 0.66 [0.29–1.52], P = 0.33). The ORs of other outcomes were similar.
ACoA aneurysms may be safely treated with either surgery or endovascular treatment, although microsurgical clipping demonstrates higher obliteration rates and lower rates of retreatment and recurrence.</description><subject>Adult</subject><subject>Aneurysm</subject><subject>Aneurysm, Ruptured - therapy</subject><subject>Anterior communicating artery</subject><subject>Child</subject><subject>Clip</subject><subject>Coil</subject><subject>Embolization, Therapeutic</subject><subject>Endovascular</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Humans</subject><subject>Intracranial Aneurysm - surgery</subject><subject>Meta-analysis</subject><subject>Retreatment</subject><subject>Subarachnoid Hemorrhage - therapy</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>1878-8750</issn><issn>1878-8769</issn><issn>1878-8769</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE9P4zAQxS20iCLgC3BAPu4lWTtuYhdxiSp2WYkViD9ny7EnxVXidG2HKjc-Oq7K9rhzmbHmvSfPD6FLSnJKaPVjnW8djHlBCpYTllNKj9ApFVxkgleLb4e5JDN0EcKapGJ0Ljg7QTPGCaW8Iqfo43n0K_ATHjy-dWZ4V0GPnfL4xYOKPbiIrcOPKto0Bry18Q3XLoK3ybAc-n50VqetW-Hax11Qnb7lp9Bf4xo_TyFCn9YaP8G7hS1WzuA_EFVWO9VNwYZzdNyqLsDFVz9Drz9vX5Z32f3Dr9_L-j7TrKxiJgxpKk1pYwivmnahgfN0jWgENekhWKs4bYRWWphCi3bOypY1reaFacy8VOwMfd_nbvzwd4QQZW-Dhq5TDoYxyIIvSlaKgtEkLfZS7YcQPLRy422v_CQpkTv4ci138OUOviRMJvjJdPWVPzY9mIPlH-okuNkLIF2ZWHgZdIKqwVgPOkoz2P_lfwINfJis</recordid><startdate>202307</startdate><enddate>202307</enddate><creator>Sattari, Shahab Aldin</creator><creator>Shahbandi, Ataollah</creator><creator>Lee, Ryan P.</creator><creator>Feghali, James</creator><creator>Rincon-Torroella, Jordina</creator><creator>Yang, Wuyang</creator><creator>Abdulrahim, Mostafa</creator><creator>Ahmadi, Sina</creator><creator>So, Raymond J.</creator><creator>Hung, Alice</creator><creator>Caplan, Justin M.</creator><creator>Gonzalez, Fernando</creator><creator>Tamargo, Rafael J.</creator><creator>Huang, Judy</creator><creator>Xu, Risheng</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4021-3153</orcidid></search><sort><creationdate>202307</creationdate><title>Surgery or Endovascular Treatment in Patients with Anterior Communicating Artery Aneurysm: A Systematic Review and Meta-Analysis</title><author>Sattari, Shahab Aldin ; Shahbandi, Ataollah ; Lee, Ryan P. ; Feghali, James ; Rincon-Torroella, Jordina ; Yang, Wuyang ; Abdulrahim, Mostafa ; Ahmadi, Sina ; So, Raymond J. ; Hung, Alice ; Caplan, Justin M. ; Gonzalez, Fernando ; Tamargo, Rafael J. ; Huang, Judy ; Xu, Risheng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-8d0b6c11bd076bf9ce771488b81d9ce83fa71b8cac8d2c8f435f3bfc72dbd45a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Aneurysm</topic><topic>Aneurysm, Ruptured - therapy</topic><topic>Anterior communicating artery</topic><topic>Child</topic><topic>Clip</topic><topic>Coil</topic><topic>Embolization, Therapeutic</topic><topic>Endovascular</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Humans</topic><topic>Intracranial Aneurysm - surgery</topic><topic>Meta-analysis</topic><topic>Retreatment</topic><topic>Subarachnoid Hemorrhage - therapy</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sattari, Shahab Aldin</creatorcontrib><creatorcontrib>Shahbandi, Ataollah</creatorcontrib><creatorcontrib>Lee, Ryan P.</creatorcontrib><creatorcontrib>Feghali, James</creatorcontrib><creatorcontrib>Rincon-Torroella, Jordina</creatorcontrib><creatorcontrib>Yang, Wuyang</creatorcontrib><creatorcontrib>Abdulrahim, Mostafa</creatorcontrib><creatorcontrib>Ahmadi, Sina</creatorcontrib><creatorcontrib>So, Raymond J.</creatorcontrib><creatorcontrib>Hung, Alice</creatorcontrib><creatorcontrib>Caplan, Justin M.</creatorcontrib><creatorcontrib>Gonzalez, Fernando</creatorcontrib><creatorcontrib>Tamargo, Rafael J.</creatorcontrib><creatorcontrib>Huang, Judy</creatorcontrib><creatorcontrib>Xu, Risheng</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sattari, Shahab Aldin</au><au>Shahbandi, Ataollah</au><au>Lee, Ryan P.</au><au>Feghali, James</au><au>Rincon-Torroella, Jordina</au><au>Yang, Wuyang</au><au>Abdulrahim, Mostafa</au><au>Ahmadi, Sina</au><au>So, Raymond J.</au><au>Hung, Alice</au><au>Caplan, Justin M.</au><au>Gonzalez, Fernando</au><au>Tamargo, Rafael J.</au><au>Huang, Judy</au><au>Xu, Risheng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgery or Endovascular Treatment in Patients with Anterior Communicating Artery Aneurysm: A Systematic Review and Meta-Analysis</atitle><jtitle>World neurosurgery</jtitle><addtitle>World Neurosurg</addtitle><date>2023-07</date><risdate>2023</risdate><volume>175</volume><spage>31</spage><epage>44</epage><pages>31-44</pages><issn>1878-8750</issn><issn>1878-8769</issn><eissn>1878-8769</eissn><abstract>Although randomized controlled trials have compared surgery versus endovascular treatment for intracranial aneurysms, the literature is sparse in terms of subgroup analysis for anterior communicating artery (ACoA) aneurysm management. This systematic review and meta-analysis sought to compare surgical versus endovascular treatment for ACoA aneurysms.
Medline, PubMed, and Embase were searched from inception to December 12, 2022. Primary outcomes were post-treatment modified Rankin Scale (mRS) >2 and mortality. Secondary outcomes were aneurysm obliteration, retreatment and recurrence, rebleeding, technical failure, vessel rupture, aneurysmal subarachnoid hemorrhage-related hydrocephalus, symptomatic vasospasm, and stroke.
Eighteen studies yielded 2368 patients, from which 1196 (50.5%) and 1172 (49.4%) patients underwent surgery and endovascular treatment, respectively. The odds ratio (OR) of mortality was similar in total (OR = 0.92 [0.63–1.37], P = 0.69), ruptured (OR = 0.92 [0.62–1.36], P = 0.66), and unruptured cohorts (OR = 1.58 [0.06–39.60], P = 0.78). The OR of mRS > 2 was similar in total (OR = 0.75 [0.50–1.13], P = 0.17), ruptured (OR = 0.77 [0.49–1.20], P = 0.25), and unruptured cohorts (OR = 0.64 [0.21–1.96], P = 0.44). The OR of obliteration was higher with surgery in the total (OR = 2.52 [1.49–4.27], P = 0.0008) and ruptured cohorts (OR = 2.61 [1.33–5.10], P = 0.005) and unruptured group (OR = 3.46 [1.30–9.20], P = 0.01). The OR of retreatment was lower with surgery in the total (OR = 0.37 [0.17–0.76], P = 0.007) and ruptured cohorts (OR = 0.31 [0.11–0.89], P = 0.03), thought it was similar in the unruptured group (OR = 0.51 [0.08–3.03], P = 0.46). The OR of recurrence was lower with surgery in the total (OR = 0.22 [0.10, 0.47], P = 0.0001), ruptured (OR = 0.16 [0.03, 0.90], P = 0.04), and mixed (un) ruptured cohorts (OR = 0.22 [0.09–0.53], P = 0.0009). The OR of rebleeding in ruptured group was similar (OR = 0.66 [0.29–1.52], P = 0.33). The ORs of other outcomes were similar.
ACoA aneurysms may be safely treated with either surgery or endovascular treatment, although microsurgical clipping demonstrates higher obliteration rates and lower rates of retreatment and recurrence.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37011760</pmid><doi>10.1016/j.wneu.2023.03.111</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0002-4021-3153</orcidid></addata></record> |
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| subjects | Adult Aneurysm Aneurysm, Ruptured - therapy Anterior communicating artery Child Clip Coil Embolization, Therapeutic Endovascular Endovascular Procedures - adverse effects Humans Intracranial Aneurysm - surgery Meta-analysis Retreatment Subarachnoid Hemorrhage - therapy Surgery Treatment Outcome |
| title | Surgery or Endovascular Treatment in Patients with Anterior Communicating Artery Aneurysm: A Systematic Review and Meta-Analysis |
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