title: Safety and efficacy of endovascular treatment for intracranial infectious aneurysms: A systematic review and meta-analysis.
abstract: BACKGROUND
  Intracranial infectious aneurysms (IIAs), or mycotic aneurysms are rare, representing between 0.7% and 5.4% of all intracranial aneurysms. To clarify the safety and efficacy of endovascular treatment of IIAs, we conducted a systematic review of the literature analyzing periprocedural and long-term clinical and angiographic outcomes.
  
  
  METHODS
  A comprehensive review of the literature for studies with ≥3 patients related to endovascular treatment of IIAs published through September 2015 was performed. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, iatrogenic rupture, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurological outcome.
  
  
  RESULTS
  We included 11 non-comparative studies with 86 target IIAs. Complete occlusion rates were 95.3% (95% CI=91.2-99.4%). Recurrence occurred in 7.9% (95% CI=2.7-13.0%). Rebleeding occurred in 5.8% (95% CI=1.4-10.3%) of patients. Procedure-related morbidity was 12.6% (95% CI=6.1-19.2%) and procedure-related mortality was 6.1% (95% CI=1.5-10.8%). Long-term good neurological outcome was 68.0% (95% CI=55.1-80.9%).
  
  
  CONCLUSIONS
  Our meta-analysis demonstrated that endovascular treatment is technically feasible and effective with high rates of IIA occlusion. Despite the comorbidities of patients, endovascular approach was associated with acceptable rates of procedure-related morbidity and satisfactory rates of overall good neurological outcome.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, 1st Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Prague, Czech Republic; Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria. Electronic address: petr.ondra@mayo.edu.
authors.forename: Ondra
authors.initials: O
authors.lastname: Petr
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Burrows
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Harry
authors.initials: H
authors.lastname: Cloft
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Kallmes
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
keywords: Endovascular treatment; Intracranial infectious aneurysms (IIAs); Meta-analysis; Mycotic