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Vertebrobasilar Dolichoectasia Future Aspects: A Meta-analysis of Clinical Features and Treatment Strategies

Nour Shaheen,Santiago Ortega-Gutierrez,E. Samaniego,Panagiotis Mastorakos,M. Gooch,P. Jabbour,Oliver Flouty,Kathleen M Dlouhy,M. Zanaty

Published 2024 in medRxiv

ABSTRACT

Background: Dolichoectatic Vertebrobasilar fusiform aneurysm (DVBFAs) presents a clinical challenge due to its complex anatomical features and associated neurological complications. This meta-analysis evaluates the clinical outcomes of endovascular treatment (EVT), open surgery, and conservative management for VBDA. Methods: A systematic review of the PubMed, Scopus, and Web of Science databases was conducted to identify studies reporting on radiologically confirmed DVBFAs. Clinical outcomes were assessed using the modified Rankin Scale (mRS) and mortality rates. Meta-regression was performed to identify potential predictors of treatment outcomes. Results: Ten studies with 219 patients were analyzed. Of the cohort, 58.4% underwent EVT, 24.6% received open surgery, and 16.9% were managed conservatively. The overall proportion of patients achieving a good clinical outcome (mRS <3) was 46.8%, with EVT showing the highest proportion at 59.4%, compared to 32.3% for open surgery and 24.7% for conservative management (p = 0.0145). The overall mortality rate was 25.98%, with EVT having the lowest mortality rate at 10.06%, followed by open surgery at 44.44% and conservative management at 63.30% (p = 0.0004). Subgroup analyses revealed statistically significant differences between treatment approaches in clinical outcomes and mortality. Conclusion: EVT appears to provide better clinical outcomes for DVBFAs, though mortality rates remain high across all treatment modalities. The absence of significant differences in subgroup analysis suggests the need for further randomized controlled trials (RCTs) of EVT vs. conservative management to establish definitive treatment guidelines.

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