Surgery or Endovascular Treatment in Patients with Anterior Communicating Artery Aneurysm: A Systematic Review and Meta-Analysis

Sattari, Shahab Aldin; Shahbandi, Ataollah; Lee, Ryan P.; Feghali, James; Rincón-Torroella, Jordina; Yang, Wuyang; Abdulrahim, Mostafa; Ahmadi, Sina; So, Raymond J.; Hung, Alice L.; Caplan, Justin M.; González, Fernando; Tamargo, Rafael J.; Huang, Judy; Xu, Risheng

doi:10.1016/j.wneu.2023.03.111

Cited by 6 publications

(3 citation statements)

References 33 publications

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“…En el tratamiento de aneurisma roto de arteria comunicante anterior, la cirugía con clipaje demostró mejores resultados (P:0,00008) y menores tasas de reintervención y recurrencia (26).…”

Section: Resultados De La Síntesisunclassified

Neurosurgical clipping vs spiral management in ruptured brain aneurysm. A systematic review

Hidalgo Acosta,

Gonzabay Jiménez,

Chávez Ruiz

et al. 2024

MedicienciasUTA

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Introducción: La rotura de aneurismas intracraneales, se pueden tratar mediante clipaje o terapia endovascular con espiral, por lo que, es necesario realizar una investigación sobre, el manejo neurocrítico y neuroquirúrgico, teniendo en consideración que la hemorragia subaracnoidea aneurismática, es una causa importante de muerte y discapacidad a nivel mundial. Objetivos: Comparar la terapia endovascular versus tratamiento quirúrgico con clipaje en pacientes con hemorragia subaracnoidea por aneurisma cerebral roto Materiales y métodos: Mediante la aplicación de criterios de inclusión y exclusión se inició la búsqueda de la revisión sistemática. Se revisaron Bases de datos como Google académico, ScienceDirect, Mendeley, Pubmed, IntechOpen, sitios web de revistas de alto prestigio, para consultar los registros e identificar estudios con el tema de búsqueda terapia endovascular versus tratamiento quirúrgico con clipaje en pacientes con hemorragia subaracnoidea por aneurisma cerebral roto. Resultados: Mayor eficacia con el tratamiento quirúrgico de los pacientes con aneurismas de la cerebral media, Rankin modificada >2 puntos: 18% para clipaje versus 24% tratamiento endovascular. Occlusion completa del aneurisma75% para el tratamiento quirúrgico versus 35% para el manejo endovascular. Oclusión completa del aneurisma. Pacientes asignados al clipaje (85%) pacientes asignados al espiral (67%). En comparación, el clipaje se asoció con una menor tasa de resangrado al alta y una mayor tasa de oclusión aneurismática a 1 año de seguimiento, la espiral redujo la tasa de vasoespasmo al alta y la tasa de resultados a 1 año fue mejor para espiral. Conclusión: La terapia endovascular, es una opción factible en pacientes con aneurismas roto de difícil abordaje quirúrgico como por ejemplo el circuito posterior cerebral, comunicante posterior, cerebelosas superiores e inferiores. El clipaje quirúrgico en el tratamiento del aneurisma cerebral roto, es la mejor opción cuando el abordaje es posible tanto por cirugía abierta, así como cirugía mínimamente invasiva, presentando altos porcentajes de oclusión completa del aneurisma. Ambas terapias representan una posibilidad en el manejo del aneurisma roto, según la localización y valorados por la escala de Rankin modificada.

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Section: Resultados De La Síntesisunclassified

Neurosurgical clipping vs spiral management in ruptured brain aneurysm. A systematic review

Hidalgo Acosta,

Gonzabay Jiménez,

Chávez Ruiz

et al. 2024

MedicienciasUTA

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“…Мікрохірургічне кліпування -добре відомий метод лікування аневризм ПСA [7,8]. Техніка передбачає доступ до аневризми через невеликий розріз на шкірі голови та черепі з наступним розміщенням металевого затискача на шийці аневризми, щоб перекрити кровотік і запобігти наступному зростанню або розриву.…”

Section: обговоренняunclassified

Microsurgical clipping of anterior communicating artery aneurysms as a method of prevention of repeated aneurysm rupture

Shkil

2023

АП

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The aim of this study is to evaluate the efficacy of microsurgical clipping of anterior communicating artery (AComA) aneurysms as a method of prevention of repeated aneurysm rupture. Materials and methods. A total of 98 patients were included in the study, with a mean age of 47.8 ± 11.0 years. The female-to-male ratio was 1.04 : 1.00. Aneurysms were verified using computer tomography of the head and neck vessels, selective cerebral angiography, and MRI angiography of cerebral vessels. Results. Pterional access was used for surgical intervention in all patients. In the first three days after the aneurysm rupture, microsurgical treatment was performed on 18 of the most severe patients. After three days and later, surgical intervention was performed in patients with compensated and sub-compensated conditions. Patients were further examined; microsurgical tactics were carefully planned. Brain compression, pronounced dislocation, and occlusive hydrocephalus were indications for emergency surgery. Angiospasm was detected in 45 patients (45.9 %), among them pronounced angiospasm was detected in 36 %, widespread – in 20 %, intracerebral hematomas – in 30 (30.6 %), intraventricular hemorrhages – in 28 (28.6 %). In five cases, intracerebral hematomas led to pronounced compression of the brain and dislocation of the middle structures. These patients underwent hematoma removal and aneurysm clipping. Half of the patients had simultaneous intraventricular hemorrhages and intracerebral hematomas of the frontal lobes and the blood was most often localized in several ventricles. Four patients with decompensated hydrocephalus underwent ventricular drainage and CSF bypass operations before aneurysm clipping. Postoperative mortality in this group of patients was 11 %, and severe neurological deficits were 22 %. It was established that repeated ruptures of AComA aneurysms occurred in 15 % of treated patients after admission to the hospital. Conclusions. Microsurgical treatment provides a minimally invasive approach that minimizes damage to the surrounding brain tissue and helps preserve brain function and minimizes the risk of postoperative neurological complications.

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“…Early clinical studies revealed no significant differences in clinical outcomes or safety between EVT and MC for ruptured AComA aneurysms ( 5 ). In a recent meta-analysis including both ruptured and unruptured aneurysms comprising 18 studies, Sattari et al reported no differences in clinical outcomes (OR = 0.77, 95% CI 0.49–1.20, p = 0.25) or mortality rates (OR = 0.92, 95% CI 0.62–1.36, p = 0.66) between the MC and EVT groups, while angiographic outcomes tended to favor MC (retreatment OR = 0.31, 95% CI 0.11–0.89, p = 0.03); recurrence (OR = 0.16, 95% CI 0.03, 0.90, p = 0.04) ( 6 ). Due to the limitations inherent in the original studies, the meta-analysis could not draw definitive conclusions.…”

Section: Introductionmentioning

confidence: 99%

The safety and clinical outcomes of endovascular treatment versus microsurgical clipping of ruptured anterior communicating artery aneurysms: a 2-year follow-up, multicenter, observational study

Yang,

Li,

et al. 2024

Front. Neurol.

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Background and objectiveCurrent data on the optimal treatment modality for ruptured anterior communicating artery (AComA) aneurysms are limited. We conducted this multicenter retrospective study to evaluate the safety and clinical outcomes of endovascular treatment (EVT) and microsurgical clipping (MC) for the treatment of ruptured AComA patients.MethodsPatients with ruptured AComA aneurysms were screened from the Chinese Multicenter Cerebral Aneurysm Database. Propensity score matching (PSM) was used to adjust for baseline characteristic imbalances between the EVT and MC groups. The safety outcomes included total procedural complications, procedure-related morbidity/death and remedial procedure for complication. The primary clinical outcome was 2-year functional independence measured by the modified Rankin scale (mRS) score.ResultsThe analysis included 893 patients with ruptured AComA aneurysms (EVT: 549; MC: 346). PSM yielded 275 pairs of patients in the EVT and MC cohorts for comparison. Decompressive craniectomy being more prevalent in the MC group (19.3% vs. 1.5%, p < 0.001). Safety data revealed a lower rate of total procedural complications (odds ratio [OR] = 0.62, 95% CI 0.39–0.99; p = 0.044) in the EVT group and similar rates of procedure-related morbidity/death (OR = 0.91, 95% CI 0.48–1.73; p = 0.880) and remedial procedure for complication (OR = 1.35, 95% CI 0.51–3.69, p = 0.657) between the groups. Compared with that of MC patients, EVT patients had a greater likelihood of functional independence (mRS score 0–2) at discharge (OR = 1.68, 95% CI 1.14–2.50; p = 0.008) and at 2 years (OR = 1.89, 95% CI 1.20–3.00; p = 0.005), a lower incidence of 2-year all-cause mortality (OR = 0.54, 95% CI 0.31–0.93; p = 0.023) and a similar rate of retreatment (OR = 1.00, 95% CI 0.23–4.40; p = 1.000).ConclusionClinical outcomes after treatment for ruptured AComA aneurysms appear to be superior to those after treatment with MC, with fewer overall procedure-related complications and no increase in the retreatment rate. Additional studies in other countries are needed to verify these findings.

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Surgery or Endovascular Treatment in Patients with Anterior Communicating Artery Aneurysm: A Systematic Review and Meta-Analysis

Cited by 6 publications

References 33 publications

Neurosurgical clipping vs spiral management in ruptured brain aneurysm. A systematic review

Neurosurgical clipping vs spiral management in ruptured brain aneurysm. A systematic review

Microsurgical clipping of anterior communicating artery aneurysms as a method of prevention of repeated aneurysm rupture

The safety and clinical outcomes of endovascular treatment versus microsurgical clipping of ruptured anterior communicating artery aneurysms: a 2-year follow-up, multicenter, observational study

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