Endovascular coiling of ruptured tiny saccular intracranial aneurysms: a systematic review and meta-analysis

Hidetoshi Matsukawa; Atakan Orscelik; Sameh Samir Elawady; Mohammad-Mahdi Sowlat; Conor M Cunningham; Sami Al Kasab; Kazutaka Uchida; Shinichi Yoshimura; Alejandro M Spiotta

doi:10.1016/j.wneu.2024.04.100

Endovascular coiling of ruptured tiny saccular intracranial aneurysms: a systematic review and meta-analysis

World Neurosurg. 2024 Apr 22:S1878-8750(24)00672-7. doi: 10.1016/j.wneu.2024.04.100. Online ahead of print.

Authors

Hidetoshi Matsukawa¹, Atakan Orscelik², Sameh Samir Elawady², Mohammad-Mahdi Sowlat², Conor M Cunningham², Sami Al Kasab², Kazutaka Uchida³, Shinichi Yoshimura⁴, Alejandro M Spiotta⁵

Affiliations

¹ Department of Neurosurgery, Medical University of South Carolina, Charleston, US; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
² Department of Neurosurgery, Medical University of South Carolina, Charleston, US.
³ Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan; Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan.
⁴ Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
⁵ Department of Neurosurgery, Medical University of South Carolina, Charleston, US. Electronic address: spiotta@musc.edu.

PMID: 38663736
DOI: 10.1016/j.wneu.2024.04.100

Abstract

Background: The safety and efficacy of endovascular coiling of ruptured tiny saccular intracranial aneurysms (IAs) (≤ 3mm) remains unknown.

Methods: A comprehensive search of PubMed, Embase, Web of Science, and Scorpus databases up to November 15, 2023 was performed. Pooled prevalence was calculated for occlusion rates, recanalization, retreatment, long-term favorable outcome, and procedure-related complications and mortality. Pooled odds ratios were calculated to compare these outcomes between coiling and stent-assisted coiling (SAC).

Results: 42 studies with 2,174 ruptured tiny saccular IAs treated with coiling were included. The follow-up complete aneurysm occlusion rate was 83.9% (95% CI: 77.2-88.9%). The rates of recanalization and retreatment were 7.7% (95% CI: 5.7-10.2%) and 5.8% (95% CI: 4.5-7.5%). The range of median Hunt and Hess grades was 1.4-2.9 and the favorable outcome rate was 85.6% (95% CI: 81.1-89.2%). The rates of thromboembolism, intraprocedural rupture, and mortality were 4.6% (95% CI: 3.6-5.8%), 5.4% (95% CI: 4.1-7.0%), and 5.6% (95% CI: 4.4-7.2%), respectively. Comparison of coiling and SAC revealed no significant difference, except for a higher likelihood of follow-up complete aneurysm occlusion in SAC (odds ratio [OR] 0.37, 95% CI: 0.17-0.80) and recanalization in the coiling (OR, 3.21 [95% CI, 1.37-7.51]).

Conclusions: Our meta-analysis demonstrates that coiling for ruptured tiny saccular IA is a feasible, effective, and safe approach that is associated with favorable clinical outcomes in both the short and long term for patients with mild to moderate Hunt and Hess grades.

Keywords: coiling; ruptured intracranial aneurysm; saccular; tiny.