Vertebrobasilar dolichoectasia future aspects: A meta-analysis of clinical features and treatment strategies.
Nour Shaheen, Santiago Ortega-Gutierrez, Edgar A Samaniego et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis compared endovascular therapy (EVT), open surgery, and conservative management for radiologically confirmed dolichoectatic vertebrobasilar fusiform aneurysms. Ten studies involving 219 patients were included. Overall, 46.8% achieved a good clinical outcome (modified Rankin Scale <3); the pooled proportion was highest with EVT at 59.4%, versus 32.3% with open surgery and 24.7% with conservative management (p = 0.0145). Mortality remained substantial overall at 25.98%, with the lowest reported rate in the EVT group. Subgroup analyses did not show significant differences between treatment approaches.
Key findings
- Good clinical outcome (mRS <3) was reported in 59.4% with EVT, 32.3% with open surgery, and 24.7% with conservative management (p = 0.0145).
- Overall mortality was 25.98%; reported mortality was 10.06% with EVT, 44.44% with open surgery, and 63.30% with conservative management (p = 0.0004).
- Pre- versus post-treatment subgroup analyses found no significant differences between treatment approaches.
Why it matters
These aneurysms are associated with neurological complications and challenging treatment decisions. The pooled results suggest better outcomes with EVT, but the high mortality across management groups and the lack of significant subgroup differences make the comparative evidence uncertain. The findings highlight the need to interpret treatment comparisons cautiously rather than assume that observed differences establish superiority.
What to keep in mind
The meta-analysis included only ten studies and 219 patients; subgroup analyses did not show significant differences, and the authors call for randomized trials.