Parent artery sacrifice for ruptured aneurysms in acute and chronic phases: A systematic review

Experience with respect to parent vessel sacrifice (PVS) for unclippable/uncoilable ruptured aneurysms is limited.

The aim of the present systematic review was to evaluate the risk of PVS for unclippable/uncoilable ruptured aneurysms.

The PUBMED and SCIENCEDIRECT databases were searched using "parent vessel occlusion OR parent artery occlusion" AND "acute subarachnoid hemorrhage" till December 27, 2015, and 1 journal was searched from November 1995 to April 2016 for relevant results.

Out of a total of 19 eligible studies, 104 patients with 104 ruptured aneurysms were treated by PVS with or without bypass surgery. Unfavorable outcome [modified Rankin Score (mRS) 4-6] was reported in 14 (13.4%) acute phase patients, with a 9.6% mortality rate. Thirty (28.8%) patients developed ischemic complications and 3 (2.9%) developed bleeding complications. The complication rate was higher for PVS in the acute phase (38.0% vs. 12.0%; P= 0.015). The unfavorable clinical outcome was found to be significant in acute phase versus chronic phase (17.7% vs. 0%; P= 0.024). The risk of morbidity associated with distal vessel [posterior cerebral artery (PCA) + superior cerebellar artery (SCA) + posterior inferior cerebellar artery (PICA)] sacrifice was not lower than that associated with major vessel [internal carotid artery (ICA) + basilar artery (BA) + vertebral artery (VA)] sacrifice (P = 0.961).

Complication and unfavorable outcome rates associated with PVS for acutely ruptured aneurysms are high. The risk of distal vessel sacrifice was not lower than major vessel sacrifice in the acute phase.