Intracranial aneurysm wall enhancement as an indicator of instability – Systematic Review and Meta‐Analysis

Background: Headaches are a major cause of disability and healthcare cost worldwide. When investigating headaches etiology, incidental unruptured intracranial aneurysms are often considered unrelated. We conducted a systematic review and meta-analysis to assess headaches outcomes (severity) after treatment of unruptured intracranial aneurysm. Methods: MEDLINE and EMBASE were systematically reviewed. Results: The data from eligible studies (n=7) was extracted and analyzed. 309 nonduplicated patients provided patient-level data for analysis. All studies used the 10-point numeric rating scale (NRS). 88% of patients were treated with endovascular technique. Overall, the observed effect estimate under a random effects model was found to be a standard mean difference in pre- and post-intervention headache severity of -0.448 (95% CI: -0.566 to -0.329). No significant heterogeneity was noted. No significant publication bias was demonstrated. Conclusions: This is the first and largest systematic review assessing postoperative headache outcomes after treatment of unruptured intracranial aneurysm. A significant reduction in headache intensity after treatment is observed in the current published literature. This study highlights an interesting clinical phenomenon that still warrants scientific effort before it can influence clinical practice. We encourage future study to stratify headache outcomes by aneurysm size, location and treatment modality.

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Efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm—A systematic review and meta-analysis

Interventional Neuroradiology ◽

10.1177/1591019920940521 ◽

2020 ◽

pp. 159101992094052 ◽

Cited By ~ 1

Author(s):

Raymond Pranata ◽

Emir Yonas ◽

Rachel Vania ◽

Prijo Sidipratomo ◽

Julius July

Keyword(s):

Systematic Review ◽

Intracranial Aneurysm ◽

Thrombus Formation ◽

Meta Analysis ◽

Class Ii ◽

Aneurysm Rupture ◽

Class I ◽

Efficacy And Safety ◽

Vessel Dissection

Objective PulseRider is a novel self-expanding nickel-titanium (nitinol) stent for treatment of wide-necked aneurysms, which is commonly located at the arterial branches in the brain. This systematic review and meta-analysis aims to assess the efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm. Method We performed a systematic literature search on articles that evaluate the efficacy and safety of PulseRider-assisted coiling of the wide-necked aneurysm from several electronic databases. The primary endpoint was adequate occlusion, defined as Raymond-Roy Class I + Raymond-Roy Class II upon immediate angiography and at six-month follow-up. Results There were a total of 157 subjects from six studies. The rate of adequate occlusion on immediate angiography was 90% (95% CI, 85%–94%) and 91% (95% CI, 85%–96%) at six-month follow-up. Of these, Raymond-Roy Class I can be observed in 48% (95% CI, 41%–56%) of aneurysms immediately after coiling, and 64% (95% CI, 55%–72%) of aneurysms on six-month follow-up. Raymond-Roy Class II was found in 30% (95% CI, 23%–37%) of aneurysms immediately after coiling, and 25% (17–33) after six-month follow-up. Complications occur in 5% (95% CI, 1%–8%) of the patients. There were three intraoperative aneurysm rupture, three thrombus formation, three procedure-related posterior cerebral artery strokes, one vessel dissection, and one delayed device thrombosis. There was no procedure/device-related death. Conclusions PulseRider-assisted coiling for treatment of patients with wide-necked aneurysm reached 90% adequate occlusion rate that rises up to 91% at sixth month with 5% complication rate.

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Is Regular Screening for Intracranial Aneurysm Necessary in Patients with Autosomal Dominant Polycystic Kidney Disease? A Systematic Review and Meta-analysis

Cerebrovascular Diseases ◽

10.1159/000476073 ◽

2017 ◽

Vol 44 (1-2) ◽

pp. 75-82 ◽

Cited By ~ 7

Author(s):

Zien Zhou ◽

Ying Xu ◽

Candice Delcourt ◽

Jiehui Shan ◽

Qiang Li ◽

...

Keyword(s):

Systematic Review ◽

Natural History ◽

Intracranial Aneurysm ◽

Intracranial Aneurysms ◽

Autosomal Dominant ◽

Meta Analysis ◽

Haemorrhagic Stroke ◽

Polycystic Kidney ◽

History Of ◽

Autosomal Dominant Polycystic Kidney

Background: The prevalence of intracranial aneurysm in patients with autosomal dominant polycystic kidney disease (ADPKD) is higher than that among the general population. We performed a systematic review and meta-analysis on the prevalence and natural history of intracranial aneurysm among patients with ADPKD. Methods: Medline, Embase, Web of Science and Scopus, from inception to July 2016, were searched for studies reporting the occurrence of intracranial aneurysms among participants with ADPKD. Two authors independently assessed the eligibility of all retrieved studies and extracted data. Information on the prevalence of intracranial aneurysms and their natural history in participants with ADPKD was collected from all included studies. Results: Fifteen studies with 1,490 participants with ADPKD were pooled to study about the prevalence of intracranial aneurysm in participants with ADPKD, and the prevalence rate was found to be 10% (95% CI 7-13%). Studies from China, Japan and Europe (Germany, Poland) reported a higher prevalence of intracranial aneurysm. Having a family history of haemorrhagic stroke or intracranial aneurysm was a risk factor for aneurysm occurrence. Twenty-three percent (95% CI 15-31%) of the participants had multiple aneurysms. Most of the aneurysms were small (<6 mm) and located in the anterior circulation. Five studies with 171 participants (83 with 106 aneurysms at baseline and 88 without) were analyzed to understand the natural history of aneurysms, with an incidence of aneurysm growth, new aneurysm and aneurysm rupture of 1.84% (followed up for 435 person-years), 0.57% (1,227 person-years) and 0.13% (792 person-years) respectively. Conclusions: Screening for intracranial aneurysm is recommended in patients with ADPKD when there is a family history of haemorrhagic stroke or intracranial aneurysm and when they are from China, Japan or Europe (Germany, Poland). Based on existing data, regular imaging follow-up is not supported. High-quality, prospective studies are needed in the future.

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