• World Neurosurg · May 2024

    Review Meta Analysis Comparative Study

    PICA-PICA Bypass versus OA-PICA Bypass for Treating Posterior Circulation Aneurysms: A Systematic Review and Comparative Meta-Analysis.

    • OliveiraLeonardo de BarrosLBDepartment of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil. Electronic address: leobarrosoliveira09@gmail.com., Marcelo Porto Sousa, Gabriel Semione, Marcio Yuri Ferreira, Sávio Batista, Lucca B Palavani, Filipi F Andreão, Jordana B C Diniz, Nicollas Nunes Rabelo, Raphael Bertani, Leonardo C Welling, Michael T Lawton, and Eberval Gadelha Figueiredo.
    • Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil. Electronic address: leobarrosoliveira09@gmail.com.
    • World Neurosurg. 2024 May 1; 185: 403416.e7403-416.e7.

    BackgroundWhen traditional therapies are unsuitable, revascularization becomes essential for managing posterior inferior cerebellar artery (PICA) or vertebral artery aneurysms. Notably, the PICA-PICA bypass has emerged as a promising option, overshadowing the occipital artery-PICA (OA-PICA) bypass. The objective was to compare the safety and efficacy of OA-PICA and PICA-PICA bypasses.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a systematic review and meta-analysis to evaluate the safety and efficacy of OA-PICA and PICA-PICA bypasses for treating posterior circulation aneurysms.ResultsWe analyzed 13 studies for the PICA-PICA bypass and 16 studies on the OA-PICA bypass, involving 84 and 110 patients, respectively. The median average follow-up for PICA-PICA bypass was 8 months (2-50.3 months), while for OA-PICA, it was 27.8 months (6-84 months). The patency rate for OA-PICA was 97% (95% confidence interval [CI]: 92%-100%) and 100% (95% CI: 95%-100%) for PICA-PICA. Complication rates were 29% (95% CI: 10%-47%) for OA-PICA and 12% (95% CI: 3%-21%) for PICA-PICA. Good clinical outcomes were observed in 71% (95% CI: 52%-90%) of OA-PICA patients and 87% (95% CI: 75%-100%) of PICA-PICA patients. Procedure-related mortality was 1% (95% CI: 0%-6%) for OA-PICA and 1% (95% CI: 0%-10%) for PICA-PICA.ConclusionsBoth procedures have demonstrated promising results in efficacy and safety. PICA-PICA exhibits slightly better patency rates, better clinical outcomes, and fewer complications, but with a lack of substantial follow-up and a smaller sample size. The choice between these procedures should be based on the surgeon's expertise and the patient's anatomy.Copyright © 2024 Elsevier Inc. All rights reserved.

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