Safety and efficacy of endovascular treatment for intracranial infectious aneurysms: A systematic review and meta-analysis

SummaryIntroductionIntracranial infectious aneurysms (IIAs), or mycotic aneurysms are rare, representing between 0.7% and 5.4% of all intracranial aneurysms. To clarify the safety and efficacy of endovascular treatment of IIAs, we conducted a systematic review of the literature analyzing periprocedural and long-term clinical and angiographic outcomes.MethodsA comprehensive review of the literature for studies with ≥ 3 patients related to endovascular treatment of IIAs published through September 2015 was performed. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, iatrogenic rupture, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurological outcome.ResultsWe included 11 non-comparative studies with 86 target IIAs. Complete occlusion rates were 95.3% (95% CI = 91.2–99.4%). Recurrence occurred in 7.9% (95% CI = 2.7–13.0%). Rebleeding occurred in 5.8% (95% CI = 1.4–10.3%) of patients. Procedure-related morbidity was 12.6% (95% CI = 6.1–19.2%) and procedure-related mortality was 6.1% (95% CI = 1.5–10.8%). Long-term good neurological outcome was 68.0% (95% CI = 55.1–80.9%).ConclusionOur meta-analysis demonstrated that endovascular treatment is technically feasible and effective with high rates of IIA occlusion. Despite the comorbidities of patients, endovascular approach was associated with acceptable rates of procedure-related morbidity and satisfactory rates of overall good neurological outcome.