TY - JOUR
T1 - Long-term rupture risk in patients with unruptured intracranial aneurysms treated with endovascular therapy
T2 - A systematic review and meta-analysis
AU - Rizvi, Asim
AU - Seyedsaadat, S. M.
AU - Alzuabi, M.
AU - Murad, M. H.
AU - Kadirvel, R.
AU - Brinjikji, W.
AU - Kallmes, D. F.
N1 - Funding Information:
Disclosures: Asim Rizvi—RELATED: Grant: 19POST34381068, Comments: American Heart Association Grant, AHA postdoctoral fellowship award*; Support for Travel to Meetings for the Study or Other Purposes: 19POST34381068, Comments: American Heart Association Grant, AHA postdoctoral fellowship award*; Other: NS076491, Comments: NIH grant*; UNRELATED: Grants/Grants Pending: 19POST34381068, Comments: This research was supported by AHA postdoctoral fellowship award # 19POST34381068 and NIH grant # NS076491.* Seyed Mohammad Seyedsaadat—RELATED: Grant: AHA 2 years postdoctoral research fellowship. Ram Kadirvel—RELATED: Grant: NIH, Comments: R01 NS076491 and R43 NS110114; Other: Cerenovus, Insera Therapeutics LLC, Marblehead Medical LLC, Microvention Inc, MIVI Neuroscience Inc, Neurogami Medical Inc, Triticum Inc, Comments: Research contracts; UNRELATED: Stock/Stock Options: Neurosigma Inc.* David Kallmes— UNRELATED: Grants/Grants Pending: Medtronic, Microvention, NeuroSigma, Neurogami, General Electric, Comments: Research support*; Stock/Stock Options: Superior Medical Experts, Comments: Founder/stockholder. *Money paid to institution.
Funding Information:
Received November 17, 2019; accepted after revision March 19, 2020. From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.) and Evidence-Based Practice Center (M.H.M.), Mayo Clinic, Rochester, Minnesota; Department of Medicine (A.R.), University of Texas Medical Branch, Galveston, Texas; and Joint Department of Medical Imaging (W.B.), Toronto Western Hospital, Toronto, Ontario, Canada. Grant support: This research was supported by AHA postdoctoral fellowship award # 19POST34381068 and NIH grant # NS076491. Please address correspondence to Asim Rizvi, MD, Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: drasimrizvi@gmail.com; @Crabalian
Publisher Copyright:
© 2020 American Society of Neuroradiology. All rights reserved.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Background: Surveillance imaging of previously unruptured, coiled aneurysms remains routine even though reports of rupture of these aneurysms are extremely rare. Purpose: We performed meta-analysis to examine long-term rupture risk over ≥1-year follow-up duration in patients with unruptured intracranial aneurysm who underwent endovascular therapy. Data Sources: Multiple databases were searched for relevant publications between 1995 and 2018. Study Selection: Studies reporting outcome of long-term rupture risk over ≥1-year follow-up in treated patients with unruptured intracranial aneurysms were included. Data Analysis: Random effects meta-analysis was used, and results were expressed as long-term rupture rate per 100 patient-year with respective 95% CIs. For ruptured aneurysms during follow-up, data were collected on size and completeness of initial Treatment. Data Synthesis: Twenty-four studies were identified. Among 4842 patients with a mean follow-up duration of 3.2 years, a total of 12 patients (0.25%) experienced rupture of previous unruptured intracranial aneurysms after endovascular treatment. Nine of these 12 patients harbored aneurysms that were large, incompletely treated, or both. A total of 2 anterior circulation, small, completely coiled aneurysms subsequently ruptured. The long-term rupture rate per 100 patient-year for unruptured intracranial aneurysms treated with endovascular therapy was 0.48 (95% CI, 0.45-0.51). Retreatment was carried out in 236 (4.9%) of these 4842 patients. Limitations: A limitation of the study is that a lack of systematic nature of follow-up and mean follow-up duration of 3.2 years are not sufficient to make general recommendations about aneurysm followup paradigms. Conclusions: Given a 5% retreatment rate, postcoil embolization spontaneous rupture of previously unruptured, small- and medium- sized, well-treated aneurysms is exceedingly rare.
AB - Background: Surveillance imaging of previously unruptured, coiled aneurysms remains routine even though reports of rupture of these aneurysms are extremely rare. Purpose: We performed meta-analysis to examine long-term rupture risk over ≥1-year follow-up duration in patients with unruptured intracranial aneurysm who underwent endovascular therapy. Data Sources: Multiple databases were searched for relevant publications between 1995 and 2018. Study Selection: Studies reporting outcome of long-term rupture risk over ≥1-year follow-up in treated patients with unruptured intracranial aneurysms were included. Data Analysis: Random effects meta-analysis was used, and results were expressed as long-term rupture rate per 100 patient-year with respective 95% CIs. For ruptured aneurysms during follow-up, data were collected on size and completeness of initial Treatment. Data Synthesis: Twenty-four studies were identified. Among 4842 patients with a mean follow-up duration of 3.2 years, a total of 12 patients (0.25%) experienced rupture of previous unruptured intracranial aneurysms after endovascular treatment. Nine of these 12 patients harbored aneurysms that were large, incompletely treated, or both. A total of 2 anterior circulation, small, completely coiled aneurysms subsequently ruptured. The long-term rupture rate per 100 patient-year for unruptured intracranial aneurysms treated with endovascular therapy was 0.48 (95% CI, 0.45-0.51). Retreatment was carried out in 236 (4.9%) of these 4842 patients. Limitations: A limitation of the study is that a lack of systematic nature of follow-up and mean follow-up duration of 3.2 years are not sufficient to make general recommendations about aneurysm followup paradigms. Conclusions: Given a 5% retreatment rate, postcoil embolization spontaneous rupture of previously unruptured, small- and medium- sized, well-treated aneurysms is exceedingly rare.
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U2 - 10.3174/ajnr.A6568
DO - 10.3174/ajnr.A6568
M3 - Review article
C2 - 32467181
AN - SCOPUS:85086346632
SN - 0195-6108
VL - 41
SP - 1043
EP - 1048
JO - American Journal of Neuroradiology
JF - American Journal of Neuroradiology
IS - 6
ER -