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Review
. 2014:2014:348147.
doi: 10.1155/2014/348147. Epub 2014 Apr 1.

Endovascular and Surgical Treatment of Unruptured MCA Aneurysms: Meta-Analysis and Review of the Literature

Spiros L Blackburn  1 , Abdelrahman M Abdelazim  2 , Andrew B Cutler  3 , Kevin T Brookins  3 , Kyle M Fargen  1 , Brian L Hoh  1 , Yasha Kadkhodayan  4
Affiliations
Review

Endovascular and Surgical Treatment of Unruptured MCA Aneurysms: Meta-Analysis and Review of the Literature

Spiros L Blackburn et al. Stroke Res Treat. 2014.

Abstract

Introduction. The best treatment for unruptured middle cerebral artery (MCA) aneurysms is unclear. We perform a meta-analysis of recent publications to evaluate the results of unruptured MCA aneurysms treated with surgical clipping and endovascular coiling. Methods. A PubMed search for articles published between January 2004 and November 2013 was performed. The R statistical software package was used to create a random effects model for each desired incidence rate. Cochran's Q test was used to evaluate possible heterogeneity among the rates observed in each study. Results. A total of 1891 unruptured MCA aneurysms, 1052 clipped and 839 coiled, were included for analysis. The complete occlusion rate at 6-9 months mean follow-up was 95.5% in the clipped group and 67.8% in the coiled group (P < 0.05). The periprocedural thromboembolism rate in the clipping group was 1.8% compared with 10.7% in the aneurysms treated by coiling (P < 0.05). The recanalization rate was 0% for clipping and 14.3% for coiling (P = 0.05). Modified Rankin scores of 0-2 were obtained in 98.9% of clipped patients compared to 95.5% of coiled (NS). Conclusions. This review weakly supports clipping as the preferred treatment of unruptured MCA aneurysms. Clinical outcomes did not differ significantly between the two groups.

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Figures

Figure 1
Figure 1
Data analysis of long-term angiographic outcome in both clipped and coiled groups.
Figure 2
Figure 2
Data analysis of thromboembolism complication in both clipped and coiled groups.
Figure 3
Figure 3
Data analysis of all morbidity cases in both clipped and coiled groups.
Figure 4
Figure 4
Data analysis of clinical outcome in both clipped and coiled groups.
See this image and copyright information in PMC

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