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Stroke Res Treat. 2014;2014:348147. doi: 10.1155/2014/348147. Epub 2014 Apr 1.

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

Author information

1
University of Florida, Department of Neurosurgery, P.O. Box 100265, Gainesville, FL 32610-0265, USA.
2
University of Florida, Department of Neurosurgery, P.O. Box 100265, Gainesville, FL 32610-0265, USA ; Assiut University, Department of Radiology, Assiut 71515, Egypt.
3
University of Florida, College of Medicine, Gainesville, FL 32603, USA.
4
Division of Interventional Neuroradiology, Abbott Northwestern Hospital, Minneapolis, MN 55407, USA.

Abstract

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.

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