A meta-analytic insight into predictors and consequences of intra-procedural rupture in unruptured intracranial aneurysms.

Abstract

Intra-procedural rupture (IPR) is a rare yet devastating complication during endovascular treatment (EVT) of unruptured intracranial aneurysms. This study aimed to systematically assess the predictors, procedural risk factors, and clinical outcomes of IPR through meta-analytic synthesis. Following PRISMA 2020 guidelines, a systematic search of PubMed and Scopus was conducted through May 2025. Eleven retrospective studies, including 11,081 unruptured aneurysms, were analyzed. Risk factors, procedural characteristics, and clinical outcomes were evaluated, and pooled proportions and odds ratios were calculated using random-effects models. The crude estimated incidence of IPR among unruptured aneurysms across all studies was approximately 6.4%. Advanced age (≥ 60 years; 99.8%), female sex (63.3%), and hypertension (44.1%) were prevalent among IPR cases. Irregular aneurysm morphology (82.9%) and anterior communicating artery (ACom) location (22.3%) emerged as significant anatomical predictors. The simple coiling technique was associated with higher IPR rates (23.4% vs. 15.7%, p < 0.001), whereas no IPR events were reported with flow diverters. Only 22.3% of patients had favorable long-term outcomes. IPR in EVT of unruptured aneurysms is rare but severe, primarily affecting elderly hypertensive females with irregular ACom aneurysms. Simple coiling techniques heighten risk, while flow diverters show promise as safer alternatives. Targeted strategies are needed to prevent this critical complication.