Intra-procedural complications, success rate, and need for retreatment of endovascular treatments in anterior communicating artery aneurysms: a systematic review and meta-analysis

Abstract

In recent years, intracranial aneurysms have been widely treated with endovascular methods. The anterior communicating artery (Acom) is the most common site of intracranial aneurysms. Despite its effectiveness, endovascular interventions can be associated with various intra-procedural and post-procedural complications. A systematic review of the literature was performed through PubMed, Embase, Scopus, and Web of Sciences databases up to March 18, 2022. The pooled rates of intra-procedural complications, mortality, procedure-related morbidities, the immediate and late aneurysm occlusion, and also the necessity for retreatment were calculated by applying random-effects models. A total of 41 articles with 4583 patients were included in the meta-analysis. The pooled rate of overall intra-procedural complications was 9.6 (95 CI: 7.7 to 11.8). The initial rupture status and also type of EVT procedure did not affect the overall complication rate. The pooled rate of intra-procedural thrombosis, aneurysm rupture, coil prolapse, and early aneurysm rebleeding were 6.1 (95 CI: 4.5 to 8.2); 4.2 (95 CI: 3.4 to 5.2), 4.7 (95 CI: 3.2 to 6.7), and 2.2 (95 CI: 1.5 to 3.2), respectively. Our analysis showed that intra-procedural mortality occurred in 1.7 (95 CI: 1.1 to 2.5) and procedure-related permanent morbidities in 3.3 (95 CI: 2.3 to 4.7) of patients. Endovascular methods achieved complete and near to complete aneurysm occlusion (Raymond-Roy occlusion classification 1 and 2) in 89.2 (95 CI: 86.4 to 92.5) of cases post-procedure, and 9.5 (95 CI: 7.3 to 12.4) of patients needed retreatment due to recanalization in follow-ups. Endovascular treatment can serve as an acceptable method for Acom aneurysms. However, improved endovascular treatment equipment and new techniques provide more satisfactory outcomes for complicated cases.