Endovascular and Surgical Treatment of Unruptured MCA Aneurysms: Meta-Analysis and Review of the Literature

Abstract EN

Introduction.

The best treatment for unruptured middle cerebral artery (MCA) aneurysms is unclear.

We perform a meta-analysis of recent publications to evaluate the results of unruptured MCA aneurysms treated with surgical clipping and endovascular coiling.

Methods.

A PubMed search for articles published between January 2004 and November 2013 was performed.

The R statistical software package was used to create a random effects model for each desired incidence rate.

Cochran’s Q test was used to evaluate possible heterogeneity among the rates observed in each study.

Results.

A total of 1891 unruptured MCA aneurysms, 1052 clipped and 839 coiled, were included for analysis.

The complete occlusion rate at 6–9 months mean follow-up was 95.5% in the clipped group and 67.8% in the coiled group ( P < 0.05 ).

The periprocedural thromboembolism rate in the clipping group was 1.8% compared with 10.7% in the aneurysms treated by coiling ( P < 0.05 ).

The recanalization rate was 0% for clipping and 14.3% for coiling ( P = 0.05 ).

Modified Rankin scores of 0–2 were obtained in 98.9% of clipped patients compared to 95.5% of coiled (NS).

Conclusions.

This review weakly supports clipping as the preferred treatment of unruptured MCA aneurysms.

Clinical outcomes did not differ significantly between the two groups.