Endovascular Coiling of Ruptured Tiny Saccular Intracranial Aneurysms: A Systematic Review and Meta-Analysis

BACKGROUND

The safety and efficacy of endovascular coiling of ruptured tiny saccular intracranial aneurysms (IAs) (≤3 mm) remain unknown.

METHODS

A comprehensive search of PubMed, Embase, Web of Science, and Scorpus databases up to November 15, 2023 was performed. Pooled prevalence was calculated for occlusion rates, recanalization, retreatment, long-term favorable outcome, and procedure-related complications and mortality. Pooled odds ratios were calculated to compare these outcomes between coiling and stent-assisted coiling (SAC).

RESULTS

Forty-two studies with 2166 ruptured tiny saccular IAs treated with coiling were included. The follow-up complete aneurysm occlusion rate was 83.9% (95% CI: 77.2-88.9%). The rates of recanalization and retreatment were 7.7% (95% CI: 5.7-10.2%) and 5.8% (95% CI: 4.5-7.5%). The range of median Hunt and Hess grades was 1.4-2.9 and the favorable outcome rate was 85.6% (95% CI: 81.1-89.2%). The rates of thromboembolism, intraprocedural rupture, and mortality were 4.6% (95% CI: 3.6-5.8%), 5.4% (95% CI: 4.1-7.0%), and 5.6% (95% CI: 4.4-7.2%), respectively. Comparison of coiling and SAC revealed no significant difference, except for a higher likelihood of follow-up complete aneurysm occlusion in SAC (odds ratio [OR] 0.37, 95% CI: 0.17-0.80) and recanalization in the coiling (OR, 3.21 [95% CI, 1.37-7.51]).

CONCLUSIONS

Our meta-analysis demonstrates that coiling for ruptured tiny saccular IA is a feasible, effective, and safe approach that is associated with favorable clinical outcomes in both the short and long term for patients with mild to moderate Hunt and Hess grades.

Community involvement in addressing the antibiotic crisis

Increasing student interest and success in STEM education is a top priority for many postsecondary educational institutions. One well-documented approach to both priorities is to have students participate in a Course Undergraduate Research Experience (CURE). Faculty from several technical colleges and universities in Wisconsin teamed up with the Tiny Earth organization to offer a CURE to address the search for new antibiotics. Students enrolled in undergraduate microbiology courses engaged in research and participated in community outreach. To involve the community, faculty from various institutions joined an NFL team, the Green Bay Packers, and created the Tiny Earth in Titletown symposium. Here, students presented their work via scientific posters, to community and industry members, and networked with other scientists from around the region. The Tiny Earth in Titletown symposium started in 2018, was held again in 2019, and returned in 2022 following a 2-year hiatus due to the COVID-19 pandemic. Record attendance in 2022 suggests that community outreach and education may be helping restore trust in science that was lost during the pandemic.