Endovascular Retreatment of Previously Clipped Intracranial Aneurysms: An Individual Patient Data Meta-analysis

作者：Keng Siang Lee, Julian Xinguang Han, Sherif R. W. Kirollos, Ramez Kirollos, Michael T. Lawton, Adam S Arthur, Pascal Jabbour · 发表于：Neurosurgery · 年份：2025 · DOI：10.1227/neu.0000000000003693 · 被引用次数：3 · 研究领域：Intracranial Aneurysms: Treatment and Complications、Meningioma and schwannoma management、Vascular Malformations Diagnosis and Treatment

BACKGROUND AND OBJECTIVES: To evaluate the effectiveness and safety of endovascular retreatment of previously clipped intracranial aneurysms (IAs). METHODS: Systematic searches of Medline, Embase and Cochrane Central were performed. The primary outcome was good functional outcome (modified Rankin Scale 0-2) at the last follow-up. Secondary outcomes included complete occlusion, and perioperative complications. One-stage individual patient data meta-analysis was performed, adjusted using generalized linear mixed models with prespecified covariables and study as a random effect. RESULTS: Twenty-six studies reporting 413 patients with 414 previously clipped IAs retreated endovascularly were included. Totally, 249 (60.1%), 39 (9.4%), 39 (9.4%), 81 (19.6%) and 6 (1.4%), underwent simple coiling, balloon-assisted coiling, stent-assisted coiling, flow diversion, and disruption, respectively. Of these, 88.6% and 11.4% IAs were located anteriorly and posteriorly. Mean size of the IAs at retreatment was 6.8 mm. Most (70.4%) of previously clipped IAs were unruptured at retreatment, mainly due to regrowth (n = 48), remnants (n = 49) or recurrences (n = 41), when reported. With clinical follow-up of 26.8 months, proportions of good functional outcomes, improved/unchanged neurological outcomes, and deaths were 77.3% (95%CI: 72.15; 81.74), 88.2% (95%CI: 64.57; 96.85), and 6.9% (95%CI: 4.19; 11.18), respectively. With angiographical follow-up of 19.4 months, the proportion of complete occlusi...