RT Journal Article
SR Electronic
T1 Flow-Diversion Treatment of Unruptured Saccular Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A5967
A1 F. Cagnazzo
A1 N. Limbucci
A1 S. Nappini
A1 L. Renieri
A1 A. Rosi
A1 A. Laiso
A1 D. Tiziano di Carlo
A1 P. Perrini
A1 S. Mangiafico
YR 2019
UL http://www.ajnr.org/content/early/2019/02/14/ajnr.A5967.abstract
AB BACKGROUND: Flow diversion for anterior communicating artery aneurysms required further investigation.PURPOSE: Our aim was to analyze outcomes after treatment of anterior communicating artery aneurysms with flow-diverter stents.DATA SOURCES: A systematic search of 3 data bases was performed for studies published from 2008 to 2018.STUDY SELECTION: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting anterior communicating artery aneurysms treated with flow diversion.DATA ANALYSIS: Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and factors influencing the studied outcomes.DATA SYNTHESIS: We included 14 studies and 148 unruptured saccular anterior communicating artery aneurysms treated with flow diversion. The long-term complete/near-complete (O'Kelly-Marotta C–D) occlusion rate was 87.4% (91/105; 95% CI, 81.3%–93.6%; I2 = 0%) (mean radiologic follow-up of 11 months). The treatment-related complication rate was 8.6% (14/126; 95% CI, 4%–13.1%; I2 = 0%), with morbidity and mortality rates of 3.5% (5/126; 95% CI, 2%–7%; I2 = 0%) and 2.5% (2/148; 95% CI, 0.3%–5%; I2 = 0%), respectively. Most complications were periprocedural (12/126 = 7%; 95% CI, 3%–11%; I2 = 0%). Thromboembolic events were slightly higher compared with hemorrhagic complications (10/126 = 6%; 95% CI, 2%–10%; I2 = 0% and 4/126 = 3%; 95% CI, 1%–6%; I2 = 0%). Branching arteries (A2 or the recurrent artery of Heubner) covered by the stent were occluded in 16% (7/34; 95% CI, 3.5%–28%; I2 = 25%) of cases. Pre- and posttreatment low-dose and high-dose of antiplatelet therapy was not associated with significantly different complication and occlusion rates.LIMITATIONS: We reviewed small and retrospective series.CONCLUSIONS: Flow diversion for unruptured saccular anterior communicating artery aneurysms appears to be an effective alternative treatment for lesions difficult to treat with coiling or microsurgical clipping. The treatment-related complication rate was relatively low. However, larger studies are needed to confirm these results.AcomAanterior communicating arteryASAacetylsalicylic acidATantiplatelet therapyCPclopidogrelIQRinterquartile rangeOKMO'Kelly-MarottaPRISMAPreferred Reporting Items for Systematic Reviews and Meta-Analyses