Towards a new treatment paradigm for XXXX ? A rapid systematic review.

@entity1 @entity548 @entity36815 @entity439 @entity954 @entity1756
BACKGROUND AND PURPOSE: Owing to their peculiar features and rare occurrence, @entity1756 (BBAs) of the internal carotid artery are challenging by both surgical and endovascular approaches and their proper management is uncertain. We therefore aimed to define the currently optimal treatment of ruptured BBAs in terms of mortality, outcome, rebleeding, and recurrence. METHOD: An in-depth search of electronic databases, gray literature and internet resources for ruptured BBAs was performed and complemented by data retrieval during neurosurgical congresses. Clinical and radiological characteristics, intervention details, outcomes, and the impact factor of the source journal were pooled. RESULTS: The pooled cohort comprised 311 @entity1 . Neither surgical nor endovascular methods had an impact on clinical outcome, @entity439 regrowth, remote @entity548 , or complication rate. By contrast, @entity439 clipping was a predictor of @entity954 ( @entity36815 ; 95% CI 1.2 to 34.3), and stent-assisted coiling increased the likelihood of a second treatment (OR 4.1; 95% CI 1.3 to 13.1), its conversion to another modality (OR 4.7; 95% CI 1.4 to 16.0), and incomplete @entity439 (OR 2.6; 95% CI 1.0 to 6.6). Higher impact journals were more likely to publish papers on endovascular techniques, particularly flow-diverter stents. CONCLUSIONS: None of the methods is unequivocally superior. Considering its inefficiency, stent-assisted coiling should be undertaken with caution. A time-delimited systematic review is needed to establish the most accurate treatment for ruptured BBAs.
