Analysis of Current Evidence in the Endovascular Treatment of Intracranial Aneurysms: A Systematic Review and Proposal for a Reporting Guideline to Enhance Reproducibility and Comparability of Surgical and Clinical Outcomes

Abstract

BACKGROUND AND OBJECTIVES: Endovascular therapy (EVT) has recently become the most widely used treatment method for intracranial aneurysms (IAs). However, the literature on this topic is heterogeneous, with studies assessing and reporting surgical and clinical outcomes in different ways, lacking standardization. We aimed to evaluate the quality of these studies and propose a reporting guideline focusing on essential elements to ensure reproducibility and comparability. METHODS: After Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we searched Medline, Embase, Cochrane Library, and Web of Science databases. Eligible studies were observational or randomized, reported clinical and/or surgical outcomes of EVTs for IAs, included over 200 patients, and were published in English between January 1, 2022, and January 1, 2024. Studies were assessed focusing on key domains: (1) reporting on the baseline characteristics of the patient sample, (2) assessment and reporting on imaging methods and aneurysm characteristics, (3) reporting on pivotal concepts definitions, (4) reporting on operator(s) and staff characteristics, (5) reporting on anesthetic protocol, (6) reporting on antiaggregant and anticoagulation therapy, (7) reporting on surgical details, (8) assessing and reporting clinical and surgical outcomes, and (9) reporting retreatment details. RESULTS: Thirty-nine studies comprising 79 604 patients were included. Our assessment revealed substantial gaps in the literature on EVTs for IAs, including deficiencies across all domains. An EndoIAs Reporting Guideline was developed, consisting of 74 items distributed across 10 domains, focusing on key surgical and clinical outcomes. CONCLUSION: Substantial deficiencies were identified in data collection and outcomes reporting in the available literature on EVT for IAs, thereby impeding comparability and reproducibility and hindering the building of cumulative evidence. The aim of the proposed EndoIAs Reporting Guideline was to address these fundamental aspects and has the potential to enhance the reproducibility and comparability of future studies, thereby fostering the building of cumulative and reliable evidence of EVT for IAs.