Background and purpose: The best management of unruptured aneurysms remains controversial. Accurate estimates of treatment-related morbidity and efficacy are needed for clinical decision making.
Methods: We review recent systematic reviews, case series and population-based studies on clipping and coiling of unruptured aneurysms. A critical analysis of the quality of available studies and of the reliability of results is followed by reappraisal of the logic of clinical research on unruptured aneurysms.
Results: Unfavourable outcome, including death, up to 1 year after surgical clipping, was found in 692 of 9845 patients (REW average: 6.7%; (99%)CI: 4.9-9.0). Unfavourable outcome after coiling occurred in 189 of 5044 patients (REW average 4.8%, ((99%)CI: 3.9-6.0). Location and size of aneurysms were risk factors for clipping, while no risk factor reached statistical significance for coiling studies. The quality of reports was in general poor. Estimates from epidemiological studies showed higher morbidity rates than reviews of case series. Treatment efficacy could not be assessed. All studies are attempts to provide answers to questions that were never properly raised.
Conclusion: Results of reviews and observational studies should serve as hypotheses for clinical trials.
Copyright © 2012. Published by Elsevier Masson SAS.