Endovascular treatment of non-ruptured intracranial aneurysms: Critical analysis of the literature

Background. -The goal was to evaluate, from the published data, the results of the endovascular treatment of unruptured aneurysms. Methods. -We have searched Medline for studies publishing results for endovascular coiling of unrupured aneurysms. Studies were classified as single-center, multicenter, or meta-analysis. Results. - Single-center studies always underestimate morbidity and mortality rates. However, it is possible to estimate mortality rate around 1.5% and morbidity rate between 3 and 6%. Some published series have directly compared results of endovascular treatment with surgical treatment. The results are always in favour of endovascular treatment, demonstrating a lower rate of complications and lower total hospital charges. Conclusion. -All published series of unruptured aneurysms favour the endovascular treatment instead of surgery. However, there is a tack of multicenter prospective series evaluating the results of the endovascular treatment of unruptured aneurysms. Likewise, there is no scientific arguments demonstrating that preventive treatment of unruptured aneurysms decreases the mortality and allows to decrease the risk of neurologic sequellae. (c) 2008 Elsevier Masson SAS. Tous droits reserves.