Ismail Mustafa, Kinjo Norito, Tahhan Imad Samman, Al-Khafaji Nooruldeen H Ali, Al-Taie Rania H, Spiotta Alejandro M
Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, 29403, USA.
Department of Surgery, College of Medicine, University of Baghdad, Baghdad, Iraq.
Neurosurg Rev. 2025 Sep 12;48(1):638. doi: 10.1007/s10143-025-03810-9.
Intra-procedural rupture (IPR) is a rare yet devastating complication during endovascular treatment (EVT) of unruptured intracranial aneurysms. This study aimed to systematically assess the predictors, procedural risk factors, and clinical outcomes of IPR through meta-analytic synthesis. Following PRISMA 2020 guidelines, a systematic search of PubMed and Scopus was conducted through May 2025. Eleven retrospective studies, including 11,081 unruptured aneurysms, were analyzed. Risk factors, procedural characteristics, and clinical outcomes were evaluated, and pooled proportions and odds ratios were calculated using random-effects models. The crude estimated incidence of IPR among unruptured aneurysms across all studies was approximately 6.4%. Advanced age (≥ 60 years; 99.8%), female sex (63.3%), and hypertension (44.1%) were prevalent among IPR cases. Irregular aneurysm morphology (82.9%) and anterior communicating artery (ACom) location (22.3%) emerged as significant anatomical predictors. The simple coiling technique was associated with higher IPR rates (23.4% vs. 15.7%, p < 0.001), whereas no IPR events were reported with flow diverters. Only 22.3% of patients had favorable long-term outcomes. IPR in EVT of unruptured aneurysms is rare but severe, primarily affecting elderly hypertensive females with irregular ACom aneurysms. Simple coiling techniques heighten risk, while flow diverters show promise as safer alternatives. Targeted strategies are needed to prevent this critical complication.
术中破裂（IPR）是未破裂颅内动脉瘤血管内治疗（EVT）期间一种罕见但具有毁灭性的并发症。本研究旨在通过荟萃分析系统评估IPR的预测因素、手术风险因素和临床结局。按照PRISMA 2020指南，截至2025年5月对PubMed和Scopus进行了系统检索。分析了11项回顾性研究，包括11081个未破裂动脉瘤。评估了风险因素、手术特征和临床结局，并使用随机效应模型计算合并比例和比值比。所有研究中未破裂动脉瘤的IPR粗估计发生率约为6.4%。IPR病例中高龄（≥60岁；99.8%）、女性（63.3%）和高血压（44.1%）较为普遍。不规则动脉瘤形态（82.9%）和前交通动脉（ACom）位置（22.3%）是显著的解剖学预测因素。单纯弹簧圈栓塞技术与较高的IPR发生率相关（23.4%对15.7%，p＜0.001），而血流导向装置未报告IPR事件。只有22.3%的患者有良好的长期结局。未破裂动脉瘤EVT中的IPR罕见但严重，主要影响患有不规则ACom动脉瘤的老年高血压女性。单纯弹簧圈栓塞技术会增加风险，而血流导向装置有望成为更安全的替代方案。需要针对性策略来预防这一关键并发症。
