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Stroke Research and Treatment
Volume 2014, Article ID 348147, 11 pages
Review Article

Endovascular and Surgical Treatment of Unruptured MCA Aneurysms: Meta-Analysis and Review of the Literature

1University of Florida, Department of Neurosurgery, P.O. Box 100265, Gainesville, FL 32610-0265, USA
2Assiut University, Department of Radiology, Assiut 71515, Egypt
3University of Florida, College of Medicine, Gainesville, FL 32603, USA
4Division of Interventional Neuroradiology, Abbott Northwestern Hospital, Minneapolis, MN 55407, USA

Received 1 January 2014; Accepted 30 January 2014; Published 1 April 2014

Academic Editor: Moneeb Ehtesham

Copyright © 2014 Spiros L. Blackburn et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. The best treatment for unruptured middle cerebral artery (MCA) aneurysms is unclear. We perform a meta-analysis of recent publications to evaluate the results of unruptured MCA aneurysms treated with surgical clipping and endovascular coiling. Methods. A PubMed search for articles published between January 2004 and November 2013 was performed. The R statistical software package was used to create a random effects model for each desired incidence rate. Cochran’s Q test was used to evaluate possible heterogeneity among the rates observed in each study. Results. A total of 1891 unruptured MCA aneurysms, 1052 clipped and 839 coiled, were included for analysis. The complete occlusion rate at 6–9 months mean follow-up was 95.5% in the clipped group and 67.8% in the coiled group ( ). The periprocedural thromboembolism rate in the clipping group was 1.8% compared with 10.7% in the aneurysms treated by coiling ( ). The recanalization rate was 0% for clipping and 14.3% for coiling ( ). Modified Rankin scores of 0–2 were obtained in 98.9% of clipped patients compared to 95.5% of coiled (NS). Conclusions. This review weakly supports clipping as the preferred treatment of unruptured MCA aneurysms. Clinical outcomes did not differ significantly between the two groups.