Basilar Apex Aneurysm: Case Series, Systematic Review, and Meta-analysis

Background: A lower rate of aneurysmal recanalization in stent assisted coiling versus coiling alone has been observed in aneurysms overall. This study aims to primarily stratify and compare degree of occlusion per treatment modality in basilar apex aneurysms. Secondary outcomes were retreatment, posttreatment hemorrhage, and procedure-related complications.

Methods: Medical literature including MEDLINE and EMBASE database was searched. We performed metaregressions, bias analysis, and fail-safe N. We controlled for the quality of the studies.

Results: Data from eligible studies (N = 12) and study center patients (n = 117) were pooled for a total of 396 nonduplicated patients. Stent-assisted coiling had a lower rate of retreatment (17% vs. 24%) and higher rate of posttreatment hemorrhage (5% vs. 3%) compared with coiling. Stent-assisted coiling had a higher rate of complete occlusion (55% vs. 45%) and a lower rate of residual aneurysm (15% vs. 23%) compared with coiling. Comparative analyses were performed. Microsurgical technique remained the most morbid treatment modality with the best rate of complete occlusion (93%) and lowest rates of rehemorrhage (2%) and retreatment (5%).

Conclusions: This is the first and largest meta-analysis focused on patients treated for basilar apex aneurysm. We report higher rehemorrhage rates with stent-assisted coiling. This study provides benchmark data to guide clinicians in future treatment decision making and encourages future research to stratify outcomes.