Surgical clipping and endovascular treatments for small or very small anterior communicating artery aneurysms: A comparative pooled analysis

Batista S.; Ferreira M.Y.; Brenner L.B.O.; Semione G.; Bocanegra-Becerra J.E.; Bertani R.; Palavani L.B.; de Macêdo Filho L.J.M.; Bertoli E.D.; Rabelo N.N.; Welling L.C.; Figueiredo E.G.; Lawton M.T. · Journal of Clinical Neuroscience (2024) · DOI: 10.1016/j.jocn.2024.110766

Resumen

Introduction: Small and very small anterior communicating artery (ACoA) aneurysms pose a complex challenge in neurosurgery and interventional neuroradiology due to their critical location and potential for severe consequences upon rupture. Surgical clipping has been a traditional approach, but it presents challenges requiring precision and expertise. Endovascular treatment has emerged as an alternative, offering minimally invasive techniques with potential advantages. This study aims to comprehensively compare outcomes and efficacy between surgical clipping and endovascular treatment for small or very small ACoA aneurysms. Objectives: We aimed to perform a meta-analysis of small or very small anterior communicating artery aneurysms comparing surgical clipping and endovascular treatments. Methods: A systematic review and meta-analysis were conducted, including studies reporting on both treatment modalities. Eligible studies were identified through PubMed, Cochrane Library, and Embase databases. Pooled analyses with 95% confidence intervals were used to compare treatment effects, and statistical analysis followed PRISMA guidelines. Results: Thirteen studies with 637 patients were included. Endovascular treatment, predominantly coiling, was performed in 60.3% of patients, while 39.7% underwent surgical management. Endovascular treatment exhibited an 18% retreatment rate, contrasting with 0% in the surgery group. Mortality rates were 3% and 6% for endovascular and surgical treatments, respectively. Overall complications occurred in 1.8% of patients, with intraoperative rupture and cerebral infarction being the most common. Conclusion: In summary, our study indicates a comparable outcome between surgical clipping and endovascular treatment for small ACoA aneurysms, with the former showing a lower retreatment rate. Decision factors include surgeon expertise, healthcare context, and patient age. Further research is needed to refine treatment strategies, considering variations in aneurysm status and evolving techniques.

Instituciones: Universidad Peruana Cayetano Heredia