Basilar apex aneurysm : case series, systematic review and meta-analysis

Abstract Background A lower rate of aneurysmal recanalization in stent assisted coiling vs coiling alone has been observed in aneurysms overall. Objective This study aims to primarily stratify and compare degree of occlusion per treatment modality in basilar apex aneurysms. Secondary outcomes were retreatment, post treatment hemorrhage and procedure-related complications. Methods Medical literature including MEDLINE and EMBASE database was searched. We performed meta-regressions, bias analysis and fail-safe N. We controlled for the quality of the studies. Results Data from eligible studies (N=12) and study center patients (n=117) were pooled for a total of 396 nonduplicated patients. Stent-assisted coiling had a lower rate of retreatment (17% vs 24%) and higher rate of post treatment haemorrhage (5% vs 3%) compared to coiling. Stent-assisted coiling had a higher rate of complete occlusion (55% vs 45%) and a lower rate of residual aneurysm (15% vs 23%) compared to coiling. Comparative analyses were performed. Microsurgical technique remained the most morbid treatment modality with the best rate of complete occlusion (93%) and lowest rates of rehemorrhage (2%) and retreatment (5%). Conlusion This is the first and largest meta-analysis focused on patients treated for basilar apex aneurysm. We report higher rehemorrhage rates with stent-assisted coiling. This study provides benchmark data to guide clinicians in future treatment decision-making and encourages future research to stratify outcomes.