Abstract
Background and Purpose
The benefits of endovascular intervention over surgery in the treatment of ruptured aneurysms of anterior circulation remains uncertain. Recently published studies did not find superiority of endovascular intervention, challenging earlier evidence from a clinical trial. The earlier evidence also had a higher than average proportion of patients in good clinical status, leading to uncertainty about external validity of earlier trials.
Methods
We performed a systematic review of studies after 2005 under a protocol published in the International Prospective Register of Systematic Reviews (PROSPERO). Primary outcomes were post-treatment rebleeding and adverse events (procedural complications). Secondary outcomes were dependency at 3-6 months and 12 months, delayed cerebral ischemia and seizures.
Results
Rebleeding was more frequent after endovascular intervention (Peto OR 2.18 95% CI 1.29 to 3.70; 3104 participants; 15 studies; I2 = 0%, GRADE: very low certainty of evidence). Fewer adverse events were reported with the endovascular intervention (RR 0.71 95% CI 0.53 to 0.95; 1661 participants; 11 studies; I2 = 14%, GRADE: low certainty of evidence). Three-to-six months dependency (RR 0.82 95% CI 0.73 to 0.93; 4081 participants; 18 studies; I2 = 15%, GRADE: low certainty of evidence) and twelve-month dependency (RR 0.76 95% CI 0.66 to 0.86; 1981 participants; 10 studies; I2 = 0%, GRADE: low certainty of evidence) were lower after endovascular intervention.
Conclusions
This study found consistent results between recent studies and the earlier evidence, in that endovascular intervention results in lower chance of dependency compared to surgery for repair of ruptured anterior circulation aneurysms. A lower proportion of patients in good clinical status in this review supports the application of the earlier evidence.
The benefits of endovascular intervention over surgery in the treatment of ruptured aneurysms of anterior circulation remains uncertain. Recently published studies did not find superiority of endovascular intervention, challenging earlier evidence from a clinical trial. The earlier evidence also had a higher than average proportion of patients in good clinical status, leading to uncertainty about external validity of earlier trials.
Methods
We performed a systematic review of studies after 2005 under a protocol published in the International Prospective Register of Systematic Reviews (PROSPERO). Primary outcomes were post-treatment rebleeding and adverse events (procedural complications). Secondary outcomes were dependency at 3-6 months and 12 months, delayed cerebral ischemia and seizures.
Results
Rebleeding was more frequent after endovascular intervention (Peto OR 2.18 95% CI 1.29 to 3.70; 3104 participants; 15 studies; I2 = 0%, GRADE: very low certainty of evidence). Fewer adverse events were reported with the endovascular intervention (RR 0.71 95% CI 0.53 to 0.95; 1661 participants; 11 studies; I2 = 14%, GRADE: low certainty of evidence). Three-to-six months dependency (RR 0.82 95% CI 0.73 to 0.93; 4081 participants; 18 studies; I2 = 15%, GRADE: low certainty of evidence) and twelve-month dependency (RR 0.76 95% CI 0.66 to 0.86; 1981 participants; 10 studies; I2 = 0%, GRADE: low certainty of evidence) were lower after endovascular intervention.
Conclusions
This study found consistent results between recent studies and the earlier evidence, in that endovascular intervention results in lower chance of dependency compared to surgery for repair of ruptured anterior circulation aneurysms. A lower proportion of patients in good clinical status in this review supports the application of the earlier evidence.
Original language | English |
---|---|
Journal | Stroke; a journal of cerebral circulation |
Early online date | 13 May 2020 |
DOIs | |
Publication status | Published - 2020 |