Ondra Petr1, Waleed Brinjikji2, Anthony M Burrows3, Harry Cloft2, David F Kallmes2, Giuseppe Lanzino3. 1. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, 1st Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Prague, Czech Republic; Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria. Electronic address: petr.ondra@mayo.edu. 2. Department of Radiology, Mayo Clinic, Rochester, MN, USA. 3. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Abstract
INTRODUCTION: Intracranial infectious aneurysms (IIAs), or mycotic aneurysms are rare, representing between 0.7% and 5.4% of all intracranial aneurysms. To clarify the safety and efficacy of endovascular treatment of IIAs, we conducted a systematic review of the literature analyzing periprocedural and long-term clinical and angiographic outcomes. METHODS: A comprehensive review of the literature for studies with ≥3 patients related to endovascular treatment of IIAs published through September 2015 was performed. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, iatrogenic rupture, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurological outcome. RESULTS: We included 11 non-comparative studies with 86 target IIAs. Complete occlusion rates were 95.3% (95% CI=91.2-99.4%). Recurrence occurred in 7.9% (95% CI=2.7-13.0%). Rebleeding occurred in 5.8% (95% CI=1.4-10.3%) of patients. Procedure-related morbidity was 12.6% (95% CI=6.1-19.2%) and procedure-related mortality was 6.1% (95% CI=1.5-10.8%). Long-term good neurological outcome was 68.0% (95% CI=55.1-80.9%). CONCLUSION: Our meta-analysis demonstrated that endovascular treatment is technically feasible and effective with high rates of IIA occlusion. Despite the comorbidities of patients, endovascular approach was associated with acceptable rates of procedure-related morbidity and satisfactory rates of overall good neurological outcome.
INTRODUCTION:Intracranial infectious aneurysms (IIAs), or mycotic aneurysms are rare, representing between 0.7% and 5.4% of all intracranial aneurysms. To clarify the safety and efficacy of endovascular treatment of IIAs, we conducted a systematic review of the literature analyzing periprocedural and long-term clinical and angiographic outcomes. METHODS: A comprehensive review of the literature for studies with ≥3 patients related to endovascular treatment of IIAs published through September 2015 was performed. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, iatrogenic rupture, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurological outcome. RESULTS: We included 11 non-comparative studies with 86 target IIAs. Complete occlusion rates were 95.3% (95% CI=91.2-99.4%). Recurrence occurred in 7.9% (95% CI=2.7-13.0%). Rebleeding occurred in 5.8% (95% CI=1.4-10.3%) of patients. Procedure-related morbidity was 12.6% (95% CI=6.1-19.2%) and procedure-related mortality was 6.1% (95% CI=1.5-10.8%). Long-term good neurological outcome was 68.0% (95% CI=55.1-80.9%). CONCLUSION: Our meta-analysis demonstrated that endovascular treatment is technically feasible and effective with high rates of IIA occlusion. Despite the comorbidities of patients, endovascular approach was associated with acceptable rates of procedure-related morbidity and satisfactory rates of overall good neurological outcome.