Authors' objectives:

This overview is intended to evaluate the efficacy of endovascular treatments with coils for the management of patients with rupture of brain aneurysms as compared with the surgical treatment and to assess the procedure's cost-effectiveness.

Authors' results and conclusions: Two studies of good methodological quality met the goal. These studies did not find differences in the mortality rate at one year of follow-up between both treatments. When the patients functional capacity was evaluated at one year, taken as the possibility to perform daily activities on their own, there was a difference in favor of the endovascular therapy, though this was a slight difference and was methodologically questionable. Endovascular therapy was associated to a higher rate of rebleeding and new procedures, though both complications were uncommon. It is necessary to consider that in the most numerous study, only patients with indication for any of the two procedures were included (they were only 20% of the patients initially selected), consequently, potential candidates to endovascular therapy would be restricted to this patient subgroup (see later).

Authors' recommendations: There are clinical conditions where surgical treatment would be most advisable. There are other cases where endovascular therapy seems to be better and a small subgroup of patients (approximately 20%) where both procedures would be a therapeutic option. Patients in which surgical treatment would be most advisable: - Aneurysms in the middle cerebral artery. - Small (<3mm) or large (>25 mm) aneurysm. - Wide-neck aneurysm (>5mm) - Hematomas and mass effect. Patients in which endovascular therapy seems to be better: - Posterior circulation (especially in the basilar artery trunk) - High surgical risk (most important predictor) - Advanced age - Brain edema and advanced Hunt&Hess. Patients in which both procedures may be a therapeutic option: Those cases not included in the previous criteria, such as medium-size aneurysm of the anterior circulation. It is also to be considered that the positive results observed in the clinical trials as to endovascular therapy are dependent on the participating centre's expertise on this technique, consequently the results cannot necessarily be extrapolated in our setting. On the other hand, most of these indications are based on experts' recommendations as until now, there is no evidence resulting from controlled clinical trials.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)