Microsurgical and endovascular treatment of large and giant aneurysms of the anterior circulation : A systematic review
Mosteiro, Alejandra (Hospital Clínic i Provincial de Barcelona)
Pedrosa, Leire (Hospital Clínic i Provincial de Barcelona)
Codes, Marta (Hospital Clínic i Provincial de Barcelona)
Reyes, Luís (Hospital Clínic i Provincial de Barcelona)
Werner, Mariano (Hospital Clínic i Provincial de Barcelona)
Amaro, Sergio (Hospital Clínic i Provincial de Barcelona)
Enseñat, Joaquim (Hospital Clínic i Provincial de Barcelona)
Rodríguez-Hernández, Ana (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Aalbers, M. (Radboud University Medical Center)
Boogaarts, J. (Radboud University Medical Center)
Torné, Ramon (Hospital Clínic i Provincial de Barcelona)
Universitat Autònoma de Barcelona

Fecha:	2024
Resumen:	Introduction: Large and Giant intracranial aneurysms (LGIAs) have become the paradigm for which endovascular techniques do not provide satisfactory results. Yet, microsurgery is followed by non-negligible rates of morbimortality. This scenario may have changed since the introduction of flow-diversion devices. Research question: Contemporary and standardised revision on microsurgical and endovascular results, with emphasis on anterior circulation LGIAs. Materials and methods: A systematic literature search was conducted in two databases (PubMed and Embase) on treatment outcomes of LGIAs of the anterior circulation, after the introduction of flow-diverters 2008/01/01, till 2023/05/20. Small case series (<5 cases), series including >15% of posterior circulation aneurysms, and studies not reporting clinical and/or angiographic outcomes were excluded. Results: 44 relevant studies (observational cohorts) were identified, including 2923 LGIAs predominantly from anterior circulation. Mean follow-up 22 (±20) months. 1494 (51%) LGIAs were treated endovascularly and 1427 (49%) microsurgically. According to the random effects model, pooled rates of favourable clinical outcomes were 85. 8% (CI 95% 82. 6-88. 4), complete occlusion 69. 4% (CI 95% 63. 7-7. 46), complications 19. 6% (CI 95%16-23. 9) and mortality 5. 6% (CI 95% 4. 4-7. 1). Focusing on type of treatment, occlusion rates are higher with microsurgical (842/993, 85% vs 874/1,299, 67%), although good outcomes are slightly more frequent with endovascular (1045/1,135, 92% vs 1120/1,294, 87%). Discussion and conclusions: According to contemporary data about occlusion rates, functional outcomes, and complications, primary or secondary treatment of LGIAs of the anterior circulation seems justified. Microsurgical occlusion rates are higher in LGIAs. An expert consensus on reporting complications and management strategies is warranted.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Clip ; Complete occlusion ; Endovascular ; Flow-diverter ; Large giant intracranial aneurysms ; Mortality ; Surgery ; Trap
Publicado en:	Brain and spine, Vol. 4 (january 2024) , p. 102838, ISSN 2772-5294

DOI: 10.1016/j.bas.2024.102838
PMID: 39071454

10 p, 8.9 MB

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Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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