Literature ReviewEndovascular Treatment of Ruptured Middle Cerebral Artery Aneurysms: A Single-Arm Meta-Analysis and Systematic Review
Introduction
Historically, neurosurgical clipping has been preferred to endovascular coiling for middle cerebral artery (MCA) aneurysms because of technological limitations. In the past decade, adjunctive balloon assistance or stent assistance have been more commonly used for these aneurysms, with comparable morbidity and mortality rates. The endovascular treatment of MCA aneurysms has been proved to be safe with comparable complication, technical failure, and repeat treatment rates.1, 2 However, for ruptured MCA aneurysms, the safety and feasibility of endovascular treatment has remained controversial.2, 3 Considering the distinctive characteristics of ruptured MCA aneurysms, the argument of whether endovascular coiling or neurosurgical clipping would be more appropriate for managing ruptured MCA aneurysms remains unclear. Therefore, we performed a meta-analysis to evaluate the safety and feasibility of endovascular management for patients with ruptured MCA aneurysms.
Section snippets
Search Strategy and Study Selection
The present systematic review and single-arm meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search and critical review of the reported data were performed to June 2018. Databases, including MEDLINE, EMBASE, the Cochrane database, and Web of Science, were searched. The title, abstract, and key words were searched using combinations of the following search terms: middle cerebral artery, intracranial or
Literature Search, Study Characteristics, and Quality Assessment
The literature search process is presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart showing the number of studies screened and excluded at each stage (Figure 1). The evidence base primarily consisted of single-arm studies. We identified 1189 studies through the database search, and a total of 14 studies1, 2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 were included in the present meta-analysis, with 1004 ruptured MCA aneurysms.
The basic characteristics of
Discussion
Considering the particular anatomical characteristics, the preference has been to treat MCA aneurysms with surgical clipping. However, the optimal treatment of MCA aneurysms has remained controversial. In previous studies, endovascular treatment of MCA aneurysms was relatively less frequent, especially for ruptured MCA aneurysms. Thus, we analyzed the clinical and angiographic results of endovascular treatment of ruptured MCA aneurysms using a meta-analysis to investigate the safety and
Conclusion
Endovascular treatment of ruptured MCA aneurysms was related to a high incidence of procedure-related complications, with, however, a low incidence of procedure-related mortality. A more dedicated and well-controlled cohort study is warranted for further evaluation of coiling and clipping for the management of ruptured MCA aneurysms.
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Procedural Complications and Factors Influencing Immediate Angiographic Results after Endovascular Treatment of Small (<5 mm) Ruptured Intracranial Aneurysms
2020, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :In the present study, immediate complete occlusion was achieved in 213 (73.4%) aneurysms, while incomplete occlusion was achieved in 77 (26.6%), including 62 (21.4%) neck remnant and 14 (4.8%) aneurysm remnants. The evaluations reported by the treating physicians in our series are very similar to those reported in other series [14-16]. The degree of initial occlusion is directly influenced by aneurysm-related anatomical factors.
Endovascular treatment of middle cerebral artery aneurysms: current status and future prospects
2023, Frontiers in Neurology
Conflict of interest statement: The present study was supported by the National Key R&D Program of China (grant 2016YFC1300700) and the National Natural Science Foundation of China (grant 81701136).
Xiaoxi Zhang, Yu Zhou and Qiao Zuo contributed equally to the present study.