Endovascular Treatment of Very Small Intracranial Aneurysms: Meta-Analysis

Yamaki, Vítor Nagai; Brinjikji, Waleed; Murad, M. Hassan; Lanzino, Giuseppe

doi:10.3174/ajnr.a4651

Cited by 56 publications

(57 citation statements)

References 33 publications

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“…27 Despite the low risk of rupture, these small aneurysms are being treated, increasingly by coiling. 14 The risks associated with surgical clipping have not been well categorized, and coiling is being performed more frequently. 31 Therefore, we focused on endovascular coiling for treatment of aneurysms in this study.…”

Section: Discussionmentioning

confidence: 99%

“…The study by Sonobe et al 11 was the only one that included both rupture and growth rates for tiny aneurysms. The outcome of coiling, including mortality, morbidity, and retreatment rates, was derived from a recent systematic review and meta-analysis by Yamaki et al 14 The incidence of de novo aneurysm formation was reported to be 0.97% per person-year by Zali et al, 21 with more than 7 years of follow-up. We assumed that the risks of rupture of de novo aneurysms were the same as for existing aneurysms, and that their risks of rupture were independent of one another.…”

Section: Clinical Parametersmentioning

confidence: 99%

“…[11][12][13] A recent meta-analysis of endovascular coiling of tiny intracranial aneurysms concluded that coiling can be performed safely and effectively, with favorable long-term angiographic and neurologic outcomes. 14 However, coil embolization of aneurysms that are 3 mm or less is particularly challenging, and the meta-analysis found a 7% intraprocedural rupture rate and a 4% incidence of thromboembolic complications. 14 These findings also must be interpreted in the context of a very low reported risk of rupture of small aneurysms.…”

mentioning

confidence: 99%

“…14 However, coil embolization of aneurysms that are 3 mm or less is particularly challenging, and the meta-analysis found a 7% intraprocedural rupture rate and a 4% incidence of thromboembolic complications. 14 These findings also must be interpreted in the context of a very low reported risk of rupture of small aneurysms. 8,11,[15][16][17] Patients with no history of SAH who are harboring aneurysms measuring 7 mm or less are often followed up conservatively using magnetic resonance angiography (MRA) to assess changes in size and/or morphologic characteristics.…”

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confidence: 99%

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Management of Tiny Unruptured Intracranial Aneurysms

et al. 2018

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UIAs) are relatively common in the general population and are being increasingly diagnosed; a significant proportion are tiny (Յ3 mm) aneurysms. There is significant heterogeneity in practice and lack of clear guidelines on the management of incidental, tiny UIAs. It is important to quantify the implications of different management strategies in terms of health benefits to patients. OBJECTIVE To evaluate the effectiveness of routine treatment (aneurysm coiling) vs 3 strategies for imaging surveillance compared with no preventive treatment or routine follow-up of tiny UIAs. DESIGN, SETTING, AND PARTICIPANTSA decision-analytic model-based comparative effectiveness analysis was conducted from May 1 to June 30, 2017, using inputs from the medical literature. PubMed searches were performed to identify relevant literature for all key model inputs, each of which was derived from the clinical study with the most robust data and greatest applicability. Analysis included 10 000 iterations simulating adult patients with incidental detections of UIAs 3 mm or smaller and no history of subarachnoid hemorrhage. INTERVENTIONSThe following 5 management strategies for tiny UIAs were evaluated: annual magnetic resonance angiography (MRA) screening, biennial MRA screening, MRA screening every 5 years, aneurysm coiling and follow-up, and no treatment or preventive follow-up. MAIN OUTCOMES AND MEASURESA Markov decision model for lifetime rupture was constructed from a societal perspective per 10 000 patients with incidental, tiny UIAs. Outcomes were assessed in terms of quality-adjusted life-years. Probabilistic, 1-way, and 2-way sensitivity analyses were performed. RESULTSIn this analysis of 10 000 iterations simulating adult patients with a mean age of 50 years, the base-case calculation shows that the management strategy of no treatment or preventive follow-up has the highest health benefit (mean [SD] quality-adjusted life-years, 19.40 [0.31]). Among the management strategies that incorporate follow-up imaging, MRA every 5 years is the best strategy with the next highest effectiveness (mean [SD] quality-adjusted life-years, 18.05 [0.62]). The conclusion remains robust in probabilistic and 1-way sensitivity analyses. No routine follow-up remains the optimal strategy when the annual growth rate and risk of rupture of growing aneurysms are varied. When the annual risk of rupture of nongrowing UIAs is less than 1.7% (0.23% in base case scenario), no follow-up is the optimal strategy. If annual risk of rupture is more than 1.7%, coiling should be performed directly. CONCLUSIONS AND RELEVANCEGiven the current literature, no preventive treatment or imaging follow-up is the most effective strategy in patients with aneurysms that are 3 mm or smaller, resulting in better health outcomes. More aggressive imaging surveillance for aneurysm growth or preventive treatment should be reserved for patients with a high risk of rupture. Given these findings, it is important to critically evaluate the appropriateness of current clinical practices, and ...

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Parametersmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Management of Tiny Unruptured Intracranial Aneurysms

et al. 2018

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“…In the literature, very small intracranial aneurysms are defined as intracranial aneurysms with a diameter smaller than or equal to 3 mm [7][8][9]. Other sources qualify these aneurysms to a group called "baby aneurysms" [10,11].…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of treatment of very small intracranial aneurysms

Jamróz¹,

Jakutowicz²,

Hofman³

et al. 2019

pjr

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Purpose: Very small intracranial aneurysms (VSIAs) may cause many neurological complications and even death. Thanks to technological progress and higher quality of non-invasive neuroimaging methods, these pathologies can be investigated sooner and treated earlier. Due to the controversy surrounding invasive treatment of these pathologies, the aim of the study was to analyse methods of treatment, their outcome, and complications in a group of patients with VSIAs. Material and methods:Out of 444 cases of intracranial aneurysms treated in our centre, 65 aneurysms met the radiological criteria of VSIAs. The parameters -width and length of the aneurysm's neck and width, length, and height of the aneurysm's dome -were measured. The analysed parameters were as follows: symptoms upon admission and after treatment, days in hospital, and intraoperative complications. Clinical and radiological intensity of subarachnoid haemorrhage (SAH) was evaluated by using the Hunt-Hess and Fisher scales. The degree of embolisation of the aneurysm after the procedure was assessed using the Montreal Scale. Clinical outcome was assessed by Glasgow Outcome Scale.Results: 50.77% of VSIAs were treated with endovascular procedures and 49.23% with neurosurgical clipping. SAH was presented in 38.46% of patients with VSIAs. Intraoperative complications were presented in 16.92% of patients with VSIAs, and the most common complication was ischaemic stroke. Stents were used in 51.52% of VSIAs. In 69.70% of embolisation procedures at VSIAs complete obliteration was achieved. The average result in the Montreal Scale was 1.31 (SD = 0.66). Conclusion:VSIAs can be treated as effectively and safely as larger aneurysms, by both endovascular and surgical methods.

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Complications in the Coiling of Cerebral Aneurysms

Brinjikji

Lanzino

2018

Cerebrovascular and Endovascular Neurosurgery

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Endovascular Treatment of Very Small Intracranial Aneurysms: Meta-Analysis

Cited by 56 publications

References 33 publications

Management of Tiny Unruptured Intracranial Aneurysms

Management of Tiny Unruptured Intracranial Aneurysms

Safety and efficacy of treatment of very small intracranial aneurysms

Complications in the Coiling of Cerebral Aneurysms

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