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Ruptured carotid-ophthalmic aneurysm treatment: a non-inferiority meta-analysis comparing endovascular coiling and surgical clipping
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.ORCID iD: 0000-0001-9107-5814
Karolinska Institute, Department of Clinical Neuroscience; Karolinska University Hospital, Department of Neuroradiology; AZ Groeninge, Department of Medical Imaging, Kortrijk.
Karolinska Institute, Department of Clinical Neuroscience; Karolinska University Hospital, Department of Neuroradiology.ORCID iD: 0000-0003-4389-5089
2017 (English)In: British Journal of Neurosurgery, ISSN 0268-8697, E-ISSN 1360-046X, Vol. 31, no 3, 345-349 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: Aneurysms of the carotid-ophthalmic segment are relatively rare, comprising only five percent of all intracranial aneurysms. There is no consensus regarding the optimal management for ruptured carotid-ophthalmic aneurysms, whether endovascular coiling or surgical clipping provide the most favourable patient outcome. The aim of this meta-analysis is to analyse these two treatment modalities for ruptured carotid-ophthalmic aneurysms with respect to independent clinical outcome.

Methods: We performed a systematic literature search in PubMed, Cochrane Central Registry of Controlled Trials and Clinicaltrials.gov for treatment of ruptured carotid-ophthalmic aneurysms, comparing endovascular coiling and surgical clipping. Primary outcome in the study was independent clinical patient outcome at follow up (defined as Glasgow Outcome Scale four–five). Secondary outcomes were poor clinical patient outcome, mortality and total angiographic occlusion. The meta-analysis was performed using the Mantel–Haenszel method for dichotomous outcome.

Results: Four studies met the inclusion criteria and were included in the meta-analysis. In total, 152 patients were included. Sixty-seven of these patients were treated with endovascular coiling and 85 patients were treated with microsurgical clipping. The proportion of patients with an independent clinical outcome after coiling and clipping was comparable, OR 1.04 (95% CI: 0.40, 2.71). The proportion of patients with an independent outcome in the endovascular group was 76% and in the surgical group 71%. Mortality between the two treatment arms was equal.

Conclusion: Clinical outcome after endovascular coiling and surgical clipping for ruptured carotid-ophthalmic aneurysms was comparable between surgical clipping and endovascular coiling. There was no proven difference in clinical outcome after endovascular coiling and surgical clipping for ruptured carotid-ophthalmic aneurysms but the evidence was based on few studies of moderate to low quality and we cannot rule out the possibility of a difference in clinical outcome between the two treatment modalities.

Place, publisher, year, edition, pages
2017. Vol. 31, no 3, 345-349 p.
Keyword [en]
Aneurysmal subarachnoid haemorrhage, aneurysm surgery, carotid-ophthalmic, clipping, coiling
National Category
Medical and Health Sciences Neurosciences Surgery
Identifiers
URN: urn:nbn:se:uu:diva-333973DOI: 10.1080/02688697.2017.1297371ISI: 000410673800018PubMedID: 28637115OAI: oai:DiVA.org:uu-333973DiVA: diva2:1158372
Available from: 2017-11-20 Created: 2017-11-20 Last updated: 2017-12-15Bibliographically approved

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Falk Delgado, AlbertoFalk Delgado, Anna

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