TY - JOUR
T1 - Surgery or Endovascular Treatment in Patients with Anterior Communicating Artery Aneurysm
T2 - A Systematic Review and Meta-Analysis
AU - Sattari, Shahab Aldin
AU - Shahbandi, Ataollah
AU - Lee, Ryan P.
AU - Feghali, James
AU - Rincon-Torroella, Jordina
AU - Yang, Wuyang
AU - Abdulrahim, Mostafa
AU - Ahmadi, Sina
AU - So, Raymond J.
AU - Hung, Alice
AU - Caplan, Justin M.
AU - Gonzalez, Fernando
AU - Tamargo, Rafael J.
AU - Huang, Judy
AU - Xu, Risheng
N1 - Funding Information:
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher Copyright:
© 2023
PY - 2023/7
Y1 - 2023/7
N2 - Background and Objective: 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. Methods: 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. Results: 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. Conclusions: 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.
AB - Background and Objective: 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. Methods: 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. Results: 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. Conclusions: 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.
KW - Aneurysm
KW - Anterior communicating artery
KW - Clip
KW - Coil
KW - Endovascular
KW - Meta-analysis
KW - Surgery
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U2 - 10.1016/j.wneu.2023.03.111
DO - 10.1016/j.wneu.2023.03.111
M3 - Review article
C2 - 37011760
AN - SCOPUS:85153865732
SN - 1878-8750
VL - 175
SP - 31
EP - 44
JO - World neurosurgery
JF - World neurosurgery
ER -