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12-10-2022 | Ruptured Aneurysm | Review

Natural history and management of posterior cerebral artery aneurysms: a systematic review and meta-analysis of individual patient data

Authors: Muhammed Amir Essibayi, Soliman H. Oushy, Zafer Keser, Giuseppe Lanzino

Published in: Neurosurgical Review | Issue 6/2022

Abstract

We conducted a comprehensive review and meta-analysis to investigate clinical, radiographic characteristics, and treatment outcomes of posterior cerebral artery aneurysms (PCAA). We systematically reviewed English-language articles investigating available treatments (parent artery occlusion (PAO), microsurgery, reconstructive endovascular (rEVT), and conservative treatments) for PCAA and analyzed the based on aneurysm morphology and rupture status. Six-hundred-eighty-five patients with 698 PCAA were identified from 59 studies. Overall, 371 (54.2%) aneurysms were ruptured, 325 (49%) were saccular, and 342 (51%) were non-saccular aneurysms. The mean age of the saccular was lower (40 years) than non-saccular aneurysm group (50 years) (P < .05). In ruptured PCAA, favorable clinical outcomes were comparable between the treatment groups except for patients treated conservatively, which had lower rates of favorable clinical outcomes (35.6%) and higher mortality (55.7%) (P < .0001). Ruptured aneurysms treated with rEVT (22.6%) had the highest recanalization rates compared to PAO (9.2%, P = 0.0001) and microsurgery (3.8%, P = 0.005). In unruptured PCAA, clinical outcomes were similar; higher complication rates were noted in microsurgery (40.4%, P = 0.026) and PAO (21.5%, P = 0.015) compared to rEVT (13.2%), which had higher recanalization rates (15.6%, P < .0001). The rates of subsequent stroke following PAO were 21.8% for unruptured and 32.3% for ruptured PCAA (P = 0.078). Ruptured PCAA portend worse prognosis and typically require an intervention to achieve better outcome whereas the benefit of an intervention in unruptured PCAA is much less clear. rEVT is promising for PCAA management with a good clinical and safety profile but more recurrence compared to PAO and microsurgery.

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Title: Natural history and management of posterior cerebral artery aneurysms: a systematic review and meta-analysis of individual patient data
Authors: Muhammed Amir Essibayi
Soliman H. Oushy
Zafer Keser
Giuseppe Lanzino
Publication date: 12-10-2022
Publisher: Springer Berlin Heidelberg
Keywords: Ruptured Aneurysm
Stroke
Aneurysm
Aneurysm
Published in: Neurosurgical Review / Issue 6/2022
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-022-01867-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Natural history and management of posterior cerebral artery aneurysms: a systematic review and meta-analysis of individual patient data

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Keynote webinar | Spotlight on medication adherence

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