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Research ArticleInterventional
Open Access

Long-Term Rupture Risk in Patients with Unruptured Intracranial Aneurysms Treated with Endovascular Therapy: A Systematic Review and Meta-Analysis

A. Rizvi, S.M. Seyedsaadat, M. Alzuabi, M.H. Murad, R. Kadirvel, W. Brinjikji and D.F. Kallmes
American Journal of Neuroradiology June 2020, 41 (6) 1043-1048; DOI: https://doi.org/10.3174/ajnr.A6568
A. Rizvi
a`From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.)
cDepartment of Medicine (A.R.), University of Texas Medical Branch, Galveston, Texas
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S.M. Seyedsaadat
a`From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.)
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  • ORCID record for S.M. Seyedsaadat
M. Alzuabi
a`From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.)
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M.H. Murad
bEvidence-Based Practice Center (M.H.M.), Mayo Clinic, Rochester, Minnesota
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R. Kadirvel
a`From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.)
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W. Brinjikji
a`From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.)
dJoint Department of Medical Imaging (W.B.), Toronto Western Hospital, Toronto, Ontario, Canada.
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D.F. Kallmes
a`From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.)
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    Fig 1.

    PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

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    Fig 2.

    Forest plot for long-term (≥1 year) rupture rate per 100 patient-year (PY) with respective 95% confidence intervals (95% CIs).

Tables

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  • Studies that reported long-term aneurysm rupture following endovascular therapy

    Author, YearNumber of Patients with Long-Term Aneurysm Rupture PosttreatmentLocation of Long-Term Aneurysm Rupture PosttreatmentReason for Rupture
    Kaku et al, 1999151Anterior (n = 1)Incomplete occlusion followed by aneurysmal recanalization and regrowth 15 months after IDC embolization on carotid angiogram. Patient had subarachnoid hemorrhage at 15 months after treatment and died.
    Johnston et al, 2000163Not explicitly reported (n = 3)Rupture caused by incomplete occlusion for technical reasons leading to delayed subarachnoid or intracranial hemorrhage during a mean follow-up duration of 3.8 years. Two patients refused follow-up angiography despite new compressive symptoms. In the third patient, only a small portion of the aneurysm could be treated, and surgical clipping was refused.
    Terada et al, 2005201Posterior (n = 1)Bilateral posterior cerebral arteries were left patent after aneurysm embolization. Fatal rupture of large basilar tip aneurysm at 28 months due to no follow-up visits and died the day before admission from a massive subarachnoid hemorrhage.
    Im et al, 2009121Anterior (n = 1)Rupture occurred 18 months after complete coil embolization of a 5-mm MCA bifurcation aneurysm. The patient was lost to clinical follow-up after initial coil embolization, which was later on completely occluded by second coil embolization. The patient had a good recovery without neurologic deficits.
    Pyysalo et al, 2013283Anterior (n = 2)
    Not explicitly reported (n = 1)
    Delayed ruptures during mean follow-up duration of 13 years. First patient with 20-mm, incompletely coiled MCA aneurysm with no follow-up due to age of 65 years. Second patient with 4-mm, completely coiled MCA aneurysm with some follow-up and rupture a couple of years later. The data were not found for the third patient.
    Mine et al, 2014291Not explicitly reported (n = 1)Delayed rupture during mean follow-up duration of 2.2 years because of incomplete coiling and refusal of further treatment.
    Petr et al, 2016321Anterior (n = 1)Delayed rupture of large MCA aneurysm and death during a mean follow-up duration of 1.7 years.
    Koyanagi et al, 2018141Posterior (n = 1)Rupture of a large (14-mm) basilar bifurcation aneurysm at 21 months.
    Total12
    • Note:—IDC indicates interlocking detachable coils.

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American Journal of Neuroradiology: 41 (6)
American Journal of Neuroradiology
Vol. 41, Issue 6
1 Jun 2020
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A. Rizvi, S.M. Seyedsaadat, M. Alzuabi, M.H. Murad, R. Kadirvel, W. Brinjikji, D.F. Kallmes
Long-Term Rupture Risk in Patients with Unruptured Intracranial Aneurysms Treated with Endovascular Therapy: A Systematic Review and Meta-Analysis
American Journal of Neuroradiology Jun 2020, 41 (6) 1043-1048; DOI: 10.3174/ajnr.A6568

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Long-Term Rupture Risk in Patients with Unruptured Intracranial Aneurysms Treated with Endovascular Therapy: A Systematic Review and Meta-Analysis
A. Rizvi, S.M. Seyedsaadat, M. Alzuabi, M.H. Murad, R. Kadirvel, W. Brinjikji, D.F. Kallmes
American Journal of Neuroradiology Jun 2020, 41 (6) 1043-1048; DOI: 10.3174/ajnr.A6568
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