Endovascular treatment of mycotic aneurysms: An update meta-analysis

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article
Data de publicação
2024
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Scopus
Web of Science
PubMed
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ELSEVIER
Autores
BATISTA, Savio
OLIVEIRA, Leonardo de Barros
FILHO, Jose Alberto Almeida
ABREU, Livia Viviani
ANDREAO, Filipi Fim
PALAVANI, Lucca B.
FILHO, Cesar A. F. Alves
BRAGA, Fausto de Oliveira
MACHADO, Elias A. T.
Citação
CLINICAL NEUROLOGY AND NEUROSURGERY, v.236, article ID 108068, 9p, 2024
Projetos de Pesquisa
Unidades Organizacionais
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Resumo
Introduction: Intracranial mycotic or infectious aneurysms result from the infection of arterial walls, most caused by bacterial or fungal organisms. These infections can weaken the arterial wall, leading to the formation of an aneurysm, a localized dilation, or a bulge. The management can be conservative mainly based on antibiotics or invasive methods such as clipping or endovascular treatment. Purpose: We performed a systematic review and meta-analysis of the current literature on endovascular treatment of mycotic aneurysms, analyzing the safety and efficacy associated with this procedure. Methods: We systematically searched on PUBMED, Cochrane Library, Embase, and Web of Science databases. Our search strategy was carefully crafted to conduct a thorough investigation of the topic, utilizing a comprehensive combination of relevant keywords. This meta-analysis included all studies that reported endovascular treatment of mycotic aneurysms. To minimize the risk of bias, studies with fewer than four patients, studies where the main outcome was not found, and studies with no clear differentiation between microsurgical and endovascular treatment were excluded. Results: In a comprehensive analysis of 134 patients, it was observed that all except one patient received anti-biotics as part of their treatment. Among the patients, 56% (a total of 51 out of 90 patients) underwent cardiac surgery. Additionally, three patients required a craniotomy following endovascular treatment. 12 patients experienced morbidity related to the procedures performed, indicating complications arising from the in-terventions. Furthermore, four aneurysms experienced rebleeding while treatment. A pooled analysis of the endovascular treatment of the mycotic aneurysm revealed a good level of technical success, achieving a 100% success rate in 12 out of 14 studies (97-100%; CI 95%; I2 = 0%), as illustrated in Fig. 2. Similarly, the aneurysm occlusion rate demonstrated a notable efficacy, with a success rate of 97% observed in 12 out of 14 studies (97-100%; CI 95%; I2 = 0%), as depicted in Fig. 3.Conclusion: The results strongly support the efficacy of endovascular treatment in achieving technical success, complete aneurysm occlusion, and favorable neurological outcomes. Additionally, the notably low incidence of complications and procedure-related mortality reaffirms the safety and benefits associated with this intervention.
Palavras-chave
Mycotic Aneurysm, Infectious Aneurysm, Endovascular Treatment
URI
https://observatorio.fm.usp.br/handle/OPI/58210
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Coleções
Artigos e Materiais de Revistas Científicas - HC/ICHC