Endovascular Treatment of Basilar Apex Aneurysms: An Updated Systematic Review and Meta-Analysis in the Era of Flow Diversion.

Basilar Apex Coiling Complications Flow Diversion Intracranial Aneurysms Reccurence Stenting

Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
25 Jul 2024
Historique:
received: 16 07 2024
accepted: 18 07 2024
medline: 28 7 2024
pubmed: 28 7 2024
entrez: 27 7 2024
Statut: aheadofprint

Résumé

Endovascular options for the treatment of basilar apex aneurysms (BAAs) are heterogeneous, and evidence is limited to retrospective cohorts and case series. We seek to evaluate the efficacy and complications associated with various endovascular treatment methods of BAAs. Systematic review of PubMed, Embase, and Web of Science adhering to the PRISMA guidelines. Retrospective and prospective studies evaluating endovascular treatment of BAAs between January 2010 and July 2024 were included. Relevant information including occlusion rates, aneurysm recurrence, retreatment rates, and complications were subjected to meta-analysis. Fifteen studies with 1,049 BAAs were included. The median aneurysm diameter was 8.5 mm (range 4.6-19.75), with a median follow-up of 33.7 months (range 6.0-117.6). Residual aneurysm filling occurred in 24% after primary coiling (95% CI=0.16-0.32), 25% after single stent-assisted coiling (s-SAC; 95% CI=0.04-0.46), 25% after Y-stenting (95% CI=0.12-0.37), and 23% after flow diverter stenting (FDS; 95% CI=0.11-0.35). Recurrence rates were high for primary coiling (27%, 95% CI=0.18-0.36) and s-SAC (19%, 95% CI=0.13-0.26), but significantly lower for Y-stenting (9%, 95% CI=0.03-0.15) and FDS (4%, 95% CI=-0.04-0.11). Retreatment rates were 19% for primary coiling (95% CI=0.12-0.26), 17% for s-SAC (95% CI=0.07-0.27), 5% for Y-stenting (95% CI=-0.03-0.12), and 13% for FDS (95% CI=-0.01-0.27). Meta-regression indicated larger aneurysms had higher complication rates (p=0.02). Thromboembolic events were most frequent with FDS and Y-stenting (12%). Occlusion rates were similar across treatments, but recurrence rates were significantly lower after Y-stenting and FDS treatments compared to primary coiling, although they carried a higher number of thromboembolic complications.

Sections du résumé

BACKGROUND BACKGROUND
Endovascular options for the treatment of basilar apex aneurysms (BAAs) are heterogeneous, and evidence is limited to retrospective cohorts and case series. We seek to evaluate the efficacy and complications associated with various endovascular treatment methods of BAAs.
METHODS METHODS
Systematic review of PubMed, Embase, and Web of Science adhering to the PRISMA guidelines. Retrospective and prospective studies evaluating endovascular treatment of BAAs between January 2010 and July 2024 were included. Relevant information including occlusion rates, aneurysm recurrence, retreatment rates, and complications were subjected to meta-analysis.
RESULTS RESULTS
Fifteen studies with 1,049 BAAs were included. The median aneurysm diameter was 8.5 mm (range 4.6-19.75), with a median follow-up of 33.7 months (range 6.0-117.6). Residual aneurysm filling occurred in 24% after primary coiling (95% CI=0.16-0.32), 25% after single stent-assisted coiling (s-SAC; 95% CI=0.04-0.46), 25% after Y-stenting (95% CI=0.12-0.37), and 23% after flow diverter stenting (FDS; 95% CI=0.11-0.35). Recurrence rates were high for primary coiling (27%, 95% CI=0.18-0.36) and s-SAC (19%, 95% CI=0.13-0.26), but significantly lower for Y-stenting (9%, 95% CI=0.03-0.15) and FDS (4%, 95% CI=-0.04-0.11). Retreatment rates were 19% for primary coiling (95% CI=0.12-0.26), 17% for s-SAC (95% CI=0.07-0.27), 5% for Y-stenting (95% CI=-0.03-0.12), and 13% for FDS (95% CI=-0.01-0.27). Meta-regression indicated larger aneurysms had higher complication rates (p=0.02). Thromboembolic events were most frequent with FDS and Y-stenting (12%).
CONCLUSION CONCLUSIONS
Occlusion rates were similar across treatments, but recurrence rates were significantly lower after Y-stenting and FDS treatments compared to primary coiling, although they carried a higher number of thromboembolic complications.

Identifiants

DOI: 10.1016/j.wneu.2024.07.142 PMID: 39067688
pubmed: 39067688
pii: S1878-8750(24)01281-6
doi: 10.1016/j.wneu.2024.07.142
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 Elsevier Inc. All rights reserved.

Auteurs

Felipe Ramirez-Velandia (F)

Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.

Aryan Wadhwa (A)

Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, United States.

Emmanuel Mensah (E)

Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.

Anvitha Sathya (A)

Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, United States.

Niels Pacheco-Barrios (N)

Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.

Jean Filo (J)

Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.

Samuel D Pettersson (SD)

Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, United States.

Alejandro Enriquez-Marulanda (A)

Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.

Michael Young (M)

Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.

Justin H Granstein (JH)

Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.

Philipp Taussky (P)

Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.

Christopher S Ogilvy (CS)

Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States. Electronic address: cogilvy@bidmc.harvard.edu.

Classifications MeSH