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Outcomes of Retreatment for Intracranial Aneurysms - A Meta-Analysis.
- Source :
-
Neurosurgery [Neurosurgery] 2019 Dec 01; Vol. 85 (6), pp. 750-761. - Publication Year :
- 2019
-
Abstract
- Background: Long-term results from the International Subarachnoid Hemorrhage Trial (ISAT) and Barrow Ruptured Aneurysm Trial (BRAT) indicate considerably higher retreatment rates for aneurysms treated with coiling compared to clipping, but do not report the outcome of retreatment.<br />Objective: To evaluate retreatment related outcomes.<br />Methods: A meta-analysis in accordance with PRISMA guidelines was conducted using Medline search engines PubMed and EMBASE to identify articles describing outcomes after retreatment for intracranial aneurysms. Pooled prevalence rates for complete occlusion rate and mortality were calculated. Outcomes of different treatment and retreatment combinations were not compared because of indication bias.<br />Results: Twenty-five articles that met the inclusion criteria were included in the meta-analysis. Surgery after coiling had a pooled complete occlusion rate of 91.2% (95% confidence interval [CI]: 87.0-94.1) and a pooled mortality rate of 5.6% (95% CI: 3.7-8.3). Coiling after coiling had a pooled complete occlusion rate of 51.3% (95% CI: 22.1-78.0) and a pooled mortality rate of 0.8% (95% CI: 0.15-3.7). Surgery after surgery did not provide a pooled estimate for complete occlusion as only one study was identified but had a pooled mortality rate of 5.9% (95% CI: 3.1-11.2). Coiling after surgery had a pooled complete occlusion rate of 56.1% (95% CI: 11.4-92.7) and a pooled mortality rate of 9.3% (95% CI: 4.1-19.9). All pooled incidence rates were produced using random-effect models.<br />Conclusion: Surgical retreatment was associated with a high complete occlusion rate but considerable mortality. Conversely, endovascular retreatment was associated with low mortality but also a low complete occlusion rate.<br /> (Copyright © 2018 by the Congress of Neurological Surgeons.)
- Subjects :
- Aneurysm, Ruptured diagnosis
Aneurysm, Ruptured mortality
Aneurysm, Ruptured therapy
Embolization, Therapeutic mortality
Endovascular Procedures mortality
Female
Humans
Intracranial Aneurysm mortality
Randomized Controlled Trials as Topic methods
Retreatment trends
Retrospective Studies
Subarachnoid Hemorrhage therapy
Treatment Outcome
Embolization, Therapeutic trends
Endovascular Procedures trends
Intracranial Aneurysm diagnosis
Intracranial Aneurysm therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4040
- Volume :
- 85
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Neurosurgery
- Publication Type :
- Academic Journal
- Accession number :
- 30445544
- Full Text :
- https://doi.org/10.1093/neuros/nyy455