title: Endovascular coiling versus parent artery occlusion for treatment of cavernous carotid aneurysms: a meta-analysis.
abstract: OBJECTIVE
  Endosaccular coil embolization and parent artery occlusion (PAO) are established endovascular techniques for treatment of cavernous carotid aneurysms. We performed a systematic review of published series on endovascular treatment of cavernous carotid aneurysms to determine outcomes and complications associated with endovascular coiling and PAO of cavernous carotid artery aneurysms.
  
  
  METHODS
  In September 2013, we conducted a computerized search of MEDLINE and EMBASE for reports on endovascular treatment of intracranial cavernous carotid aneurysms from January 1990 to August 2013. Comparisons were made in periprocedural complications and outcomes between coiling and PAO patients who did not receive bypass. Event rates were pooled across studies using random effects meta-analysis.
  
  
  RESULTS
  20 studies with 509 patients and 515 aneurysms were included in this systematic review. Aneurysm occlusion rates at >3 months after operation were significantly higher in the PAO without bypass group (93.0%, 95% CI 86.0 to 97.0) compared with the coiling group (67.0%, 95% CI 55.0 to 77.0) (p<0.01). Retreatment rates were significantly lower in the PAO without bypass group (6.0%, 95% CI 2.0 to 12.0) compared with the coiling group (18.0%, 95% CI 12.0 to 26.0) (p=0.01). Coiling patients had a similar morbidity rate (3.0%, 95% CI 2.0 to 6.0) compared with PAO without bypass patients (7.0%, 95% CI 3.0 to 12.0) (p=0.13). Coiling patients had a similar mortality rate (0.0%, 95% CI 0.0 to 6.0) compared with PAO without bypass patients (4.0%, 95% CI 1.0 to 9.0) (p=0.68).
  
  
  CONCLUSIONS
  Evidence from non-comparative studies suggests that traditional endovascular options are highly effective in treating cavernous sinus aneurysms. PAO is associated with a higher rate of complete occlusion. Periprocedural morbidity and mortality rates are not negligible, especially in patients receiving PAO.
authors.affiliation: College of Human Medicine, Michigan State University, East Lansing, Michigan, USA.
authors.forename: Zaahir A
authors.initials: ZA
authors.lastname: Turfe
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Center for Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Cloft
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Kallmes
mesh_terms: D021721:Balloon Occlusion / Q000379:methods* / Q000401:mortality; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods* / Q000401:mortality; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009026:Mortality / Q000639:trends; D016896:Treatment Outcome
keywords: Aneurysm; Intervention; Subarachnoid