Abstract：
OBJECTIVE: Anterior choroidal artery (AChA) aneurysms account for 2%-5% of all intracranial aneurysms. Treatment considerations include microsurgical clipping, flow diversion, or coiling with or without adjunctive devices. AChA aneurysms pose challenges in treatment due to the origination of the aneurysm from the origin or proximal segment of the AChA. The AChA is particularly susceptible to vasospasm and occlusion during treatment with devastating neurological deficits, including hemiparesis, hemianesthesia, lethargy, neglect, and hemianopia. In this study, the authors performed a meta-analysis to quantify the outcomes and complication rates across treatment modalities for AChA aneurysms and to identify risk factors reported in the literature.
METHODS: The authors performed a systematic review of AChA aneurysms treated with surgical clipping, endovascular coiling, or flow diversion and reported in the PubMed, Embase, Scopus, and Cochrane search databases. Single-arm meta-analyses of the selected outcomes were performed in RStudio.
RESULTS: Literature review yielded 25 studies that met the inclusion criteria. In total, 1627 patients were included in the analysis, with 554 males, 1009 females, and 64 unspecified. The rate of any complication in the full cohort was 11.6%, with a rate of ischemic complications of 5.5% and a favorable recovery rate of 90.3% of all patients treated. In total, 1064 patients underwent surgical clipping, 443 were treated with coiling, and 120 patients with flow diversion. In clipped patients, the rate of total surgical complications was 17.6%, with an ischemic complication rate of 9.4%. The rate of good functional recovery, defined on the basis of a Glasgow Outcome Scale score of 4-5 or modified Rankin Scale score of 0-2, was 88.0%, and complete obliteration was achieved in 84.5% of surgically clipped aneurysms. The complication rate in coiled patients was 10.3%, with an ischemic complication rate of 3.0%. Good functional recovery was achieved in 88.6% of coiled patients and complete aneurysm obliteration in 74.1%. Flow diversion resulted in a complication rate of 1.3%, with 0.7% rate of ischemic complications. Good functional recovery was achieved in 98.4% of patients and complete aneurysm obliteration in 79.0% in the flow diversion group. Aneurysm morphological features that impacted the complication rate were also identified to augment quantitative data and to help guide treatment selection for AChA aneurysms.
CONCLUSIONS: Flow diversion showed significantly lower total and ischemic complications and improved outcomes compared to clipping and coiling. There may be differences in outcomes between treatment types, especially when considering the varied patient presentations that guide treatment selection.
METHODS: The authors performed a systematic review of AChA aneurysms treated with surgical clipping, endovascular coiling, or flow diversion and reported in the PubMed, Embase, Scopus, and Cochrane search databases. Single-arm meta-analyses of the selected outcomes were performed in RStudio.
RESULTS: Literature review yielded 25 studies that met the inclusion criteria. In total, 1627 patients were included in the analysis, with 554 males, 1009 females, and 64 unspecified. The rate of any complication in the full cohort was 11.6%, with a rate of ischemic complications of 5.5% and a favorable recovery rate of 90.3% of all patients treated. In total, 1064 patients underwent surgical clipping, 443 were treated with coiling, and 120 patients with flow diversion. In clipped patients, the rate of total surgical complications was 17.6%, with an ischemic complication rate of 9.4%. The rate of good functional recovery, defined on the basis of a Glasgow Outcome Scale score of 4-5 or modified Rankin Scale score of 0-2, was 88.0%, and complete obliteration was achieved in 84.5% of surgically clipped aneurysms. The complication rate in coiled patients was 10.3%, with an ischemic complication rate of 3.0%. Good functional recovery was achieved in 88.6% of coiled patients and complete aneurysm obliteration in 74.1%. Flow diversion resulted in a complication rate of 1.3%, with 0.7% rate of ischemic complications. Good functional recovery was achieved in 98.4% of patients and complete aneurysm obliteration in 79.0% in the flow diversion group. Aneurysm morphological features that impacted the complication rate were also identified to augment quantitative data and to help guide treatment selection for AChA aneurysms.
CONCLUSIONS: Flow diversion showed significantly lower total and ischemic complications and improved outcomes compared to clipping and coiling. There may be differences in outcomes between treatment types, especially when considering the varied patient presentations that guide treatment selection.
摘要：
目的：脉络膜前动脉（AChA）动脉瘤占所有颅内动脉瘤的2％-5％。治疗考虑因素包括显微外科手术夹闭，导流,或卷绕有或没有辅助装置。由于动脉瘤从AChA的起源或近端段起源，因此AChA动脉瘤在治疗中提出了挑战。在治疗期间，AChA特别容易受到血管痉挛和闭塞的影响，包括偏瘫,半麻醉,嗜睡,疏忽,和偏盲。在这项研究中,作者进行了一项荟萃分析,以量化AChA动脉瘤不同治疗方式的结局和并发症发生率,并确定文献中报道的危险因素.
方法：作者对手术夹闭治疗的AChA动脉瘤进行了系统评价，血管内卷绕，或流量转移，并在PubMed中报告，Embase,Scopus,和Cochrane搜索数据库。在RStudio中对选定结果进行单臂荟萃分析。
结果：文献综述得出25项符合纳入标准的研究。总的来说,1627名患者被纳入分析，有554名男性，1009名女性,和64未指定。整个队列中任何并发症的发生率为11.6％，缺血性并发症的发生率为5.5％，所有治疗患者的康复率为90.3％。总的来说,1064例患者接受手术夹闭，443用卷取处理，和120例分流患者。在夹住的病人中，手术总并发症发生率为17.6%,缺血性并发症发生率为9.4%。良好的功能恢复率，根据格拉斯哥结果量表得分为4-5分或改良的兰金量表得分为0-2分，为88.0％，在84.5%的手术夹闭动脉瘤中实现了完全闭塞。患者并发症发生率为10.3%，缺血并发症发生率为3.0%。88.6％的卷曲患者实现了良好的功能恢复，74.1％的动脉瘤完全闭塞。分流导致并发症发生率为1.3%，缺血并发症发生率为0.7%。在分流组中，98.4%的患者实现了良好的功能恢复，79.0%的患者实现了动脉瘤完全闭塞。还确定了影响并发症发生率的动脉瘤形态学特征，以增加定量数据并帮助指导AChA动脉瘤的治疗选择。
结论：与夹闭和卷绕相比，分流术显示出显著降低的总并发症和缺血性并发症，并改善了预后。治疗类型之间的结果可能存在差异，特别是在考虑指导治疗选择的各种患者介绍时。
方法：作者对手术夹闭治疗的AChA动脉瘤进行了系统评价，血管内卷绕，或流量转移，并在PubMed中报告，Embase,Scopus,和Cochrane搜索数据库。在RStudio中对选定结果进行单臂荟萃分析。
结果：文献综述得出25项符合纳入标准的研究。总的来说,1627名患者被纳入分析，有554名男性，1009名女性,和64未指定。整个队列中任何并发症的发生率为11.6％，缺血性并发症的发生率为5.5％，所有治疗患者的康复率为90.3％。总的来说,1064例患者接受手术夹闭，443用卷取处理，和120例分流患者。在夹住的病人中，手术总并发症发生率为17.6%,缺血性并发症发生率为9.4%。良好的功能恢复率，根据格拉斯哥结果量表得分为4-5分或改良的兰金量表得分为0-2分，为88.0％，在84.5%的手术夹闭动脉瘤中实现了完全闭塞。患者并发症发生率为10.3%，缺血并发症发生率为3.0%。88.6％的卷曲患者实现了良好的功能恢复，74.1％的动脉瘤完全闭塞。分流导致并发症发生率为1.3%，缺血并发症发生率为0.7%。在分流组中，98.4%的患者实现了良好的功能恢复，79.0%的患者实现了动脉瘤完全闭塞。还确定了影响并发症发生率的动脉瘤形态学特征，以增加定量数据并帮助指导AChA动脉瘤的治疗选择。
结论：与夹闭和卷绕相比，分流术显示出显著降低的总并发症和缺血性并发症，并改善了预后。治疗类型之间的结果可能存在差异，特别是在考虑指导治疗选择的各种患者介绍时。
