Abstract

The growth of unruptured intracranial aneurysms (UIAs) is a strong predictor of rupture. Clinical observations suggest that some UIAs might grow faster after endovascular treatment than untreated UIAs. There are no head-to-head comparisons of incidence rates of UIAs thus far. MethodsWe searched PubMed, Embase and Google Scholar for relevant articles from the inception of the databases to March 2020. We pooled and compared the incidence rates for the growth of aneurysms from natural history studies and endovascular treatment studies. Generalized linear models were used for confounder adjustment for the prespecified confounders age, size and location. ResultsTwenty-five studies (10 describing growth in natural history and 15 reporting growth after endovascular therapy) considering 6325 aneurysms were included in the meta-analysis. The median size of aneurysms was 3.7 mm in the natural history studies and 6.4 mm in endovascular treatment studies (p = 0.001). The pooled incidence rate (IR) of growth was significantly higher in endovascular treatment studies (IR 52 per 1000 person-years, with a 95% confidence interval (CI) 36–79) compared to natural history studies (IR 28 per 1000 person-years, 95% CI 17 – 46, p-value < 0.01) after adjustment for confounders. ConclusionOur results suggest that the incidence rate of cerebral aneurysm growth might be higher after endovascular therapy than the incidence rates reported in natural history studies. These results should be viewed in light of the risk of bias of the individual studies and the risk of ecological bias.

Highlights

  • The growth of unruptured intracranial aneurysms (UIAs) is a predictor for aneurysm rupture

  • 25 studies (10 describing growth in natural history and 15 reporting growth after endovascular therapy) with 6325 aneurysms were included in the meta-analysis

  • The pooled incidence rate (IR) of growth was significantly higher in endovascular treatment studies (IR 52 per 1000 person-years, 95% Confidence Interval (CI) 36–79) compared to natural history studies (IR 28 per 1000 person-years, 95% CI 17–46), after adjustment

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Summary

Introduction

The growth of unruptured intracranial aneurysms (UIAs) is a predictor for aneurysm rupture. Growth of an aneurysm may often play an important role in the decision to treat UIAs. the predictors of growth are the same as the predictors for rupture.[1,6] At this moment, despite advances in neuroimaging, there are no studies which allow in-depth characterization of this process. Treatment of UIAs in order to prevent eventual rupture relies either on endovascular techniques, such as coiling, or open surgical techniques, microsurgical clip reconstruction of the parent vessel. Both techniques have particular risk profiles and treatment is usually tailored to patient and aneurysm characteristics.

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