Management Outcomes of Dolichoectatic Vertebrobasilar Artery Aneurysms: A Systematic Review and Meta-analysis

Introduction: The prognosis of patients with dolichoectatic vertebrobasilar artery aneurysms (DVBAAs) remains dismal and their management is extremely challenging. The aim of this report was to delineate the efficacy, clinical outcomes, and complications of open cerebrovascular surgery, endovascular surgery, and conservative management of DVBAAs.

Methods: PubMed, Scopus, Web of Science, and Cochrane databases were searched for relevant publications. Per PRISMA guidelines, clinical presentation, management, clinical outcomes—good (improved or stable clinical condition) or poor (deteriorated patient’s condition or death)—, and mortality rates were all reported and statistically analyzed.

Results: Nine studies described 41 patients (27.5%) who had open cerebrovascular surgery, 61 (40.9%) had endovascular surgery, and 47 (31.5%) were managed conservatively for their DVBAAs. The total cohort’s good and poor outcome rates were 51.9% (95% CI: 28.3-74.6%) and 45.5% (95% CI: 23.0-70.1%), respectively. The cohort’s mortality rate was 22.3% (95% CI: 11.8-38.0%). The treatment groups were comparable regarding good clinical outcome rates (open cerebrovascular surgery group: 24.7% [95% CI: 2.9-78.2%]; endovascular surgery group: 69.0% [95% CI: 28.7-92.5%]; conservative management group: 57.7% [95% CI: 13.0-92.5%]; p=0.19), poor outcome rates (open vascular surgery group: 75.3% [95% CI: 21.8-97.1%]; endovascular surgery group: 27.2% [95% CI: 5.6-0.70.2%]; conservative management group: 39.9% [95% CI: 9.1-81.6%]; p=0.15), and mortality rates (open vascular surgery group: 39.5% [95% CI: 11.4-76.8%]; endovascular surgery group: 15.8% [95% CI: 4.4-43.0%]; conservative management group: 19.2% [95% CI: 6.8-43.5%]; p=0.23).

Conclusion : Regardless of the treatment approach, the current study of DVBAA demonstrated poor clinical outcomes and significant mortality rates. Weighing the risks and benefits of each management paradigm with a personalized treatment approach is advice.