A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish?
| Autor: | Amin Aghaebrahim, Manuel F Granja, Guilherme J. Agnoletto, Ricardo A. Hanel, Eric Sauvageau, Sara Jamal, Andre Monteiro |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Subarachnoid hemorrhage medicine.medical_treatment 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aneurysm medicine.artery Basilar artery Medicine Humans Embolization Aged Aged 80 and over business.industry Mortality rate Angiography Digital Subtraction Intracranial Aneurysm General Medicine Clipping (medicine) Perioperative Middle Aged medicine.disease Trunk Embolization Therapeutic Surgery Treatment Outcome Female Stents Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Journal of neurointerventional surgery. 12(4) |
| ISSN: | 1759-8486 |
| Popis: | Background and purposeNon-trunk basilar artery perforator aneurysms (BAPAs) are rare intracranial vascular pathologies that have long been underdiagnosed, under-reported, and under-analyzed. We performed a systematic review of the efficacy and safety endpoints between conservative and active treatment approaches for non-trunk BAPAs.MethodsMajor databases were analyzed for relevant publications between 1995 and 2019. Studies comparing the outcomes between conservative and active treatment approaches such as coiling, stenting, clipping, liquid embolization, and flow diversion were included. Mortality rate, rate of permanent neurological deficit as determined by the modified Rankin Score (mRS), rate of second treatment occurrence, and perioperative complication rate were also assessed.ResultsA total of 24 studies, including 54 patients with 56 non-trunk BAPAs, were included. The mean maximum aneurysm diameter was 2.70 mm (range 1–10). A diagnosis was achieved with the initial DSA in 50.0% (27/54) of the patients. A conservative approach was used in 16 patients while active treatment was used in the other 38. Thirteen of 15 (86.7%) patients in the conservative group and 27/34 (79.4%) in the active treatment group had an mRS score 0–2. A non-significant higher odds of a positive outcome was observed in the conservative group (OR 1.51, 95% CI 0.50 to 4.54). The event-related mortality rate was 3.55% (3/54) with one procedure-related death in the active treatment group.ConclusionsIn patients with non-trunk BAPAs unamenable to active treatment, conservative approaches may result in acceptable functional outcomes and low morbidity. Small sample sizes and under-reporting of outcomes warrant further study. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|