Posterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery Bypass versus Occipital Artery-Posterior Inferior Cerebellar Artery Bypass for Treating Posterior Circulation Aneurysms: A Systematic Review and Comparative Meta-Analysis.
World Neurosurg
; 185: 403-416.e7, 2024 05.
Article
em En
| MEDLINE
| ID: mdl-38458251
ABSTRACT
BACKGROUND:
When traditional therapies are unsuitable, revascularization becomes essential for managing posterior inferior cerebellar artery (PICA) or vertebral artery aneurysms. Notably, the PICA-PICA bypass has emerged as a promising option, overshadowing the occipital artery-PICA (OA-PICA) bypass. The objective was to compare the safety and efficacy of OA-PICA and PICA-PICA bypasses.METHODS:
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a systematic review and meta-analysis to evaluate the safety and efficacy of OA-PICA and PICA-PICA bypasses for treating posterior circulation aneurysms.RESULTS:
We analyzed 13 studies for the PICA-PICA bypass and 16 studies on the OA-PICA bypass, involving 84 and 110 patients, respectively. The median average follow-up for PICA-PICA bypass was 8 months (2-50.3 months), while for OA-PICA, it was 27.8 months (6-84 months). The patency rate for OA-PICA was 97% (95% confidence interval [CI] 92%-100%) and 100% (95% CI 95%-100%) for PICA-PICA. Complication rates were 29% (95% CI 10%-47%) for OA-PICA and 12% (95% CI 3%-21%) for PICA-PICA. Good clinical outcomes were observed in 71% (95% CI 52%-90%) of OA-PICA patients and 87% (95% CI 75%-100%) of PICA-PICA patients. Procedure-related mortality was 1% (95% CI 0%-6%) for OA-PICA and 1% (95% CI 0%-10%) for PICA-PICA.CONCLUSIONS:
Both procedures have demonstrated promising results in efficacy and safety. PICA-PICA exhibits slightly better patency rates, better clinical outcomes, and fewer complications, but with a lack of substantial follow-up and a smaller sample size. The choice between these procedures should be based on the surgeon's expertise and the patient's anatomy.Palavras-chave
Texto completo:
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Bases de dados:
MEDLINE
Assunto principal:
Procedimentos Cirúrgicos Vasculares
/
Aneurisma Intracraniano
/
Revascularização Cerebral
Limite:
Humans
Idioma:
En
Revista:
World Neurosurg
Assunto da revista:
NEUROCIRURGIA
Ano de publicação:
2024
Tipo de documento:
Article