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Interventional management for infectious intracranial aneurysms (IIAs) shows better short-term outcomes than medical treatment alone. However, observational data limitations mean these findings are hypothesis-generating, not causal.

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Area of Science:

  • Neurology
  • Vascular Surgery
  • Interventional Neuroradiology

Background:

  • Infectious intracranial aneurysms (IIAs) are rare, high-risk vascular lesions.
  • Optimal management strategies remain uncertain due to low incidence and lack of randomized trials.

Purpose of the Study:

  • To systematically review and synthesize comparative observational evidence on interventional versus medical management of IIAs.
  • To evaluate the effectiveness and safety of different treatment approaches for IIAs.

Main Methods:

  • Searched PubMed, Embase, and Cochrane Library for comparative observational studies.
  • Included studies comparing interventional (surgical/endovascular) with medical management for IIAs.
  • Synthesized outcomes using random-effects meta-analysis, assessing risk of bias and certainty of evidence.

Main Results:

  • Thirteen studies (748 patients) showed interventional management associated with higher treatment success, lower mortality, and reduced rupture risk.
  • Interventional strategies demonstrated significantly better short-term clinical and angiographic outcomes.
  • Substantial risk of bias, confounding, and imprecise reporting limit definitive conclusions.

Conclusions:

  • Observational data suggest interventional management may be superior for short-term IIA outcomes.
  • Confounding by indication and study limitations prevent causal inference.
  • Findings are hypothesis-generating, highlighting the need for higher-quality evidence.