Safety and Efficacy of Surgical and Endovascular Treatment for Distal Anterior Cerebral Artery Aneurysms: A Systematic Review and Meta-Analysis

World Neurosurg. 2017 Apr;100:557-566. doi: 10.1016/j.wneu.2016.11.134. Epub 2016 Dec 5.

Abstract

Background: Aneurysms of the distal anterior cerebral artery (DACA) are rare, representing between 1% and 9% of all intracranial aneurysms. The best treatment strategy for these aneurysms continues to be debated.

Objective: We conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies of DACA aneurysms.

Methods: A systematic search of Medline, Embase, Scopus, and Web of Science was performed for studies published from January 2000 to August 2015. We included studies describing treatment of DACA aneurysms with ≥10 patients. Random effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality and stroke rates, aneurysm recurrence/rebleed, and long-term neurologic morbidity/mortality.

Results: Thirty studies with 1329 DACA aneurysms were included. Complete occlusion was 95% (95% confidence interval [CI], 91.0%-97.0%) in the surgical group and 68% (95% CI, 56.0%-78.0%) in the endovascular group (P < 0.0001). Aneurysm recurrence occurred in 3% (95% CI, 2.0%-4.0%) after surgery and in 19.1% (95% CI, 12.0%-27.0%) after endovascular treatment (P < 0.0001). Overall neurologic morbidity and mortality were 15% (95% CI, 11.0%-21.0%) and 9% (95% CI, 7.0%-11.0%) after surgery and 14% (95% CI, 10.0%-19.0%) (P = 0.725) and 7% (95% CI, 5.0%-10.0%) (P = 0.422) after endovascular treatment, respectively. Overall long-term favorable neurologic outcome was 80% and it was equal in both groups (80%; 95% CI, 73.0%-85.0% in the surgical group and 80%; 95% CI, 72.0%-87.0% in the endovascular group) (P = 0.892).

Conclusions: Our meta-analysis showed that both treatment modalities are technically feasible and effective with sufficient long-term aneurysm occlusion and acceptable recurrence/rebleed rates. Surgical treatment is associated with superior angiographic outcomes. There were no substantial differences in procedure-related morbidity and mortality. These findings are important because they suggest that therapy of DACA aneurysms should be performed on a selective, case-by-case basis to maximize patient benefits.

Keywords: Aneurysm; DACA; Endovascular treatment; Meta-analysis; Microsurgery.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cerebral Hemorrhage / mortality*
  • Cerebral Revascularization / mortality*
  • Cerebral Revascularization / statistics & numerical data
  • Combined Modality Therapy / mortality
  • Combined Modality Therapy / statistics & numerical data
  • Comorbidity
  • Endovascular Procedures / mortality*
  • Endovascular Procedures / statistics & numerical data
  • Female
  • Humans
  • Intracranial Aneurysm / diagnosis
  • Intracranial Aneurysm / mortality*
  • Intracranial Aneurysm / therapy*
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis
  • Postoperative Complications / mortality*
  • Prevalence
  • Risk Factors
  • Survival Rate
  • Treatment Outcome
  • Young Adult