• A Rizvi, S M Seyedsaadat, M Alzuabi, M H Murad, R Kadirvel, W Brinjikji, and D F Kallmes.
• From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.) drasimrizvi@gmail.com.
• AJNR Am J Neuroradiol. 2020 Jun 1; 41 (6): 1043-1048.

BackgroundSurveillance imaging of previously unruptured, coiled aneurysms remains routine even though reports of rupture of these aneurysms are extremely rare.PurposeWe 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 SourcesMultiple databases were searched for relevant publications between 1995 and 2018.Study SelectionStudies reporting outcome of long-term rupture risk over ≥1-year follow-up in treated patients with unruptured intracranial aneurysms were included.Data AnalysisRandom 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 SynthesisTwenty-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.LimitationsA 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.ConclusionsGiven a 5% retreatment rate, postcoil embolization spontaneous rupture of previously unruptured, small- and medium-sized, well-treated aneurysms is exceedingly rare.© 2020 by American Journal of Neuroradiology.

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