title: Clinical and Radiological Outcomes After Treatment of Unruptured Paraophthalmic Internal Carotid Artery Aneurysms: a Comparative and Pooled Analysis of Single-Center Experiences.
abstract: OBJECTIVE
  Unruptured paraophthalmic aneurysms present unique challenges, and the ideal management remains unknown.
  
  
  METHODS
  We performed a pooled analysis of single-center experiences to compare the risks and effectiveness involving patients with unruptured paraophthalmic aneurysms treated with clipping, coiling alone, stent-assisted coiling, and flow-diversion. The MEDLINE database was searched and thirty-three series (including our institutional experience) were included.
  
  
  RESULTS
  Clipping caused more intracranial hemorrhage (ICH) and neurologic complications (NCs) than coiling alone (ICH: odds ratio [OR] = 3.058, P = 0.013; NC: OR = 5.809, P < 0.001), stent-assisted coiling (ICH: P = 0.018; NC: OR = 7.367, P < 0.001), and flow-diversion (ICH: P = 0.006; NC: OR = 16.954, P < 0.001). Clipping also caused more unfavorable visual outcomes than both coiling alone (OR = 3.037, P = 0.001) and stent-assisted coiling (OR = 6.055, P = 0.005). Clipping resulted in a lower reoperation rate than coiling alone in large/giant aneurysm group, which approached statistical significance (OR = 0.133, P = 0.057). Clipping, stent-assisted coiling, and flow-diversion all showed higher occlusion rates compared with coiling alone (OR [clipping vs. coiling alone] = 2.852, P ≤ 0.001; OR [coiling alone vs. stent-assisted coiling] = 0.302, P = 0.003; OR [coiling alone vs. flow-diversion] = 0.400, P = 0.013). Flow-diversion showed comparative complication rate, clinical outcomes, and angiographic result compared with stent-assisted coiling. No significant differences were found among all 4 treatment modalities on mortality and poor outcome.
  
  
  CONCLUSIONS
  Endovascular therapies have benefits over surgical clipping in terms of fewer intracranial hemorrhage complications, fewer NCs, and lower unfavorable visual outcome rate. Flow diversion showed comparative safety and effectiveness to stent-assisted coiling, and they both achieved better radiologic results than coiling alone. Further validation by randomized cohort studies is still needed to provide robust evidence.
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
authors.forename: Jianwei
authors.initials: J
authors.lastname: Pan
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Shen
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
authors.forename: Zuoxu
authors.initials: Z
authors.lastname: Fan
authors.affiliation: Department of Epidemiology and Health Statistics, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Shen
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Wen
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Tong
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China. Electronic address: 06yxsyzy@163.com.
authors.forename: Renya
authors.initials: R
authors.lastname: Zhan
mesh_terms: D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000601:surgery*; D002533:Cerebral Angiography; D004172:Diplopia / Q000209:etiology; D004244:Dizziness / Q000209:etiology; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D016017:Odds Ratio; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014717:Vertigo / Q000209:etiology
keywords: Clip; Coil; Flow diversion; Outcomes; Paraophthalmic aneurysm; Stent-assisted coil; Unruptured intracranial aneurysm