Evidence map›Paper›PMID 37480480›Full record

ArticleNeuroradiology2023

A shift from open to endovascular repair in the treatment of ruptured middle cerebral artery aneurysms: a single institution experience.

Jose Danilo Bengzon Diestro, Yangmei Li, Kislay Kishore, Abdelsimar T Omar, Walter Montanera, Dipanka Sarma, Thomas R Marotta, Julian Spears, Aditya Bharatha

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In one paragraph

Article in Neuroradiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 2 pooled it
1.2field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 2 syntheses or guidelines pooled it, 6 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 1 institution in 1 country.

Jose Danilo Bengzon DiestroDepartment of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada. danni.diestro@gmail.com.ORCID http://orcid.org/0000-0001-8450-2021
Yangmei LiDepartment of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada.
Kislay KishoreDepartment of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada.
Abdelsimar T OmarDepartment of Surgery, Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
Walter MontaneraDepartment of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada.
Dipanka SarmaDepartment of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada.
Thomas R MarottaDepartment of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada.
Julian SpearsDepartment of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada.
Aditya BharathaDepartment of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada.
St. Michael's Hospital · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeMiddle cerebral aneurysms were underrepresented in the two largest trials (BRAT and ISAT) for the treatment of ruptured intracranial aneurysms. Recent institutional series addressing the choice between endovascular or open repair for this subset of aneurysms are few and have not yielded a definitive conclusion. We compare clinical outcomes of patients presenting with acute subarachnoid hemorrhage from ruptured middle cerebral artery aneurysms undergoing either open or endovascular repair.

methodsWe conducted a retrospective review of 138 consecutive patients with ruptured middle cerebral artery aneurysms admitted into our institution from January 2008 to March 2019 to compare endovascular and open surgical outcomes.

resultsOf the ruptured middle cerebral artery aneurysms, 57 underwent endovascular repair while 81 were treated with open surgery. Over the study period, there was a notable shift in practice toward more frequent endovascular treatment of ruptured MCA aneurysms (31% in 2008 vs. 91% in 2018). At discharge (49.1% vs 29.6%; p = .002) and at 6 months (84.3% vs 58.6%; p = 0.003), patients who underwent endovascular repair had a higher proportion of patients with good clinical outcomes (mRS 0-2) compared to those undergoing open surgery. Long-term follow-up data (endovascular 54.9 ± 37.9 months vs clipping 18.6 ± 13.4 months) showed no difference in rebleeding (1.8% vs 3.7%, p = 0.642) and retreatment (5.3% vs 3.7%, p = 0.691) in both groups.

conclusionOur series suggests equipoise in the treatment of ruptured middle cerebral artery aneurysms and demonstrates endovascular repair as a potentially feasible treatment strategy. Future randomized trials could clarify the roles of these treatment modalities.

Indexed as

Aneurysm, RupturedEmbolization, TherapeuticEndovascular ProceduresIntracranial AneurysmSubarachnoid HemorrhageHumansRetrospective StudiesTreatment OutcomeEndovascular coilingMiddle cerebral aneurysmNeurosurgical clipping

Identifiers

PMID37480480
OpenAlexW4385075086

What OpenQuestion holds

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Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.