Endovascular Treatment of Ruptured Middle Cerebral Artery Aneurysms: A Single-Arm Meta-Analysis and Systematic Review

OBJECTIVE: The use of endovascular treatment for ruptured middle cerebral artery (MCA) aneurysms, which have been more likely to be recommended for neurosurgical clipping because of the complex anatomic configuration, remains controversial. In the present study, the angiographic and clinical outcomes of endovascularly treated ruptured MCA aneurysms were systematically reviewed. METHODS: Online databases, including Cochrane, Medline, Web of Science, and Embase, were retrospectively and systematically searched. The primary outcomes were the immediate complete occlusion rate, mortality, complication-related mortality, and procedure-related complication rate. Meta-analysis was performed using a random or fixed effect model based on heterogeneity. RESULTS: A total of 14 studies with 1004 ruptured MCA aneurysms were included. The procedure-related mortality rate at discharge was 1.8% (95% confidence interval [CI], 0.9%-2.7%; I-2 = 0.0%; P = 0.623). The favorable clinical outcome rate at discharge was 65.4% (95% CI, 54.8%-76.0%; I-2 = 94.2%; P < 0.001) and had progressively increased to 73.2% (95% CI, 59.9%-86.5%; I-2 = 80.9%; P < 0.001). The overall complication rate was 22.7% (95% CI, 15.1%-30.3%; I-2 = 75.5%; P < 0.001). CONCLUSION: Endovascular treatment of MCA aneurysms was related to a high incidence of procedure-related complications but a low rate of procedure-related mortality. The overall angiographic and clinical outcomes were comparable and warrant further investigation comparing clipping versus coiling for ruptured MCA aneurysms.