• Neurosurgery · Dec 2019

    Meta Analysis

    Outcomes of Retreatment for Intracranial Aneurysms - A Meta-Analysis.

    • Ivo S Muskens, Omar Hertgers, Lycklama À Nijeholt Geert J GJ Department of Radiology, Haaglanden Medical Center, The Hague, The Netherlands., Broekman Marike L D MLD Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands. , and Wouter A Moojen.
    • Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands.
    • Neurosurgery. 2019 Dec 1; 85 (6): 750-761.

    BackgroundLong-term results from the International Subarachnoid Hemorrhage Trial (ISAT) and Barrow Ruptured Aneurysm Trial (BRAT) indicate considerably higher retreatment rates for aneurysms treated with coiling compared to clipping, but do not report the outcome of retreatment.ObjectiveTo evaluate retreatment related outcomes.MethodsA meta-analysis in accordance with PRISMA guidelines was conducted using Medline search engines PubMed and EMBASE to identify articles describing outcomes after retreatment for intracranial aneurysms. Pooled prevalence rates for complete occlusion rate and mortality were calculated. Outcomes of different treatment and retreatment combinations were not compared because of indication bias.ResultsTwenty-five articles that met the inclusion criteria were included in the meta-analysis. Surgery after coiling had a pooled complete occlusion rate of 91.2% (95% confidence interval [CI]: 87.0-94.1) and a pooled mortality rate of 5.6% (95% CI: 3.7-8.3). Coiling after coiling had a pooled complete occlusion rate of 51.3% (95% CI: 22.1-78.0) and a pooled mortality rate of 0.8% (95% CI: 0.15-3.7). Surgery after surgery did not provide a pooled estimate for complete occlusion as only one study was identified but had a pooled mortality rate of 5.9% (95% CI: 3.1-11.2). Coiling after surgery had a pooled complete occlusion rate of 56.1% (95% CI: 11.4-92.7) and a pooled mortality rate of 9.3% (95% CI: 4.1-19.9). All pooled incidence rates were produced using random-effect models.ConclusionSurgical retreatment was associated with a high complete occlusion rate but considerable mortality. Conversely, endovascular retreatment was associated with low mortality but also a low complete occlusion rate.Copyright © 2018 by the Congress of Neurological Surgeons.

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