Systematic Review and Meta-Analysis of Endovascular Therapy Effectiveness for Unruptured Saccular Intracranial Aneurysms

Abstract

ABSTRACTBackgroundCurrently, endovascular treatment of intracranial aneurysms (ICAs) is limited by low complete occlusion rates. The advent of novel endovascular technology has expanded the applicability of endovascular therapy; however, the superiority of novel embolic devices over the traditional Guglielmi detachable coils (GDCs) is still debated. We performed a systematic review of literature that reported the Raymond-Roy occlusion classifications (RROC) rates of modern endovascular devices to determine their immediate and long-term occlusion effectiveness for the treatment of unruptured saccular ICAs.MethodsA search was conducted using electronic databases (PUBMED, Cochrane,ClinicalTrials.gov, Web of Science). We retrieved studies published between 2000-2022 reporting immediate and long-term RROC rates of subjects treated with different endovascular ICA therapies. We extracted demographic information of the treated patients and their reported angiographic RROC rates.ResultsA total of 80 studies from 15 countries were included for data extraction. RROC rates determined from angiogram were obtained for 21,331 patients (72.5% females, pooled mean age: 58.2 (95% CI: 56.8-59.6), harboring 22,791 aneurysms. The most frequent aneurysm locations were the internal carotid artery (46.4%, 95% CI: 41.9%-50.9%), the anterior communicating artery (26.4%, 95% CI: 22.5%-30.8%), the middle cerebral artery (24.5%, 95% CI:19.2%-30.8%) and the basilar tip (14.4%, 95% CI:11.3%-18.3%). The RROC rates were analyzed for GDCs, the Woven EndoBridge (WEB), and flow diverters. The immediate complete occlusion (RROC-I) rate was the highest in balloon-assisted coiling (73.9%, 95% CI: 65.0%-81.2%) and the lowest in the WEB (27.8%, 95% CI:13.2%-49.2%). The long-term complete occlusion probability was homogenous in all analyzed devices.ConclusionsWe observed that the coil-based endovascular therapy provides acceptable rates of complete occlusion, where the balloon-assisted coils provide greater probability of immediate complete occlusion. Out of the analyzed devices, the WEB exhibited the shortest time to achieve >90% probability of long-term complete occlusion (∼18 months). Overall, the GDCs remain thegold standardfor endovascular treatment of unruptured saccular aneurysms.