{
  "abstract": "Background Infectious intracranial aneurysms (IIAs) are highly morbid vascular lesions, and the comparative effectiveness of medical management (MM), surgery, and endovascular treatment (EVT) remains uncertain.Objective To perform a systematic review and network meta-analysis comparing the three main interventions for IIAs: MM, open surgery, and EVT.Methods A systematic review and frequentist network meta-analysis were conducted. Studies comparing MM, open surgery, and EVT in patients with IIAs were included. The primary outcome was treatment success, defined according to study-specific definitions and operationally harmonized as the absence of treatment failure. Secondary outcomes included mortality, rupture or re-rupture, recurrence, neurological deficits, and complications. Random-effects models estimated odds ratios (ORs) with 95% confidence intervals (CIs). Treatment ranking was assessed using P scores, and heterogeneity was quantified using I².Results Thirteen observational studies were included. In an exploratory network meta-analysis, both EVT (OR=2.51; 95% CI 1.22 to 5.15) and surgery (OR=7.29; 95% CI 2.00 to 26.55) were associated with higher odds of treatment success compared with MM. EVT was associated with a lower risk of aneurysm rupture or re-rupture compared with MM (OR=0.42; 95% CI 0.18 to 0.96), whereas no statistically significant differences were observed between EVT and surgery. Given the non-randomized nature of the evidence and methodological heterogeneity across studies, these findings should be interpreted with caution.Conclusions EVT and surgery were associated with higher odds of treatment success compared with MM, whereas EVT was additionally associated with a lower risk of rupture or re-rupture. These findings should be interpreted cautiously given the observational nature of the available evidence.",
  "authors": [
    {
      "affiliations": [
        "Southern Santa Catarina University, Palhoça, Brazil"
      ],
      "name": "Iago Nathan Simon Petry"
    },
    {
      "affiliations": [
        "Federal University of Piaui, Teresina, PI, Brazil"
      ],
      "name": "Ocílio Ribeiro Gonçalves"
    },
    {
      "affiliations": [
        "Federal University of Pará Institute of Medical Sciences, Belém, Brazil"
      ],
      "name": "Rafael Reis de Oliveira"
    },
    {
      "affiliations": [
        "University of Pará State, Belém, Brazil"
      ],
      "name": "Kaike Lobo"
    },
    {
      "affiliations": [
        "Federal University of Santa Maria, Santa Maria, RS, Brazil"
      ],
      "name": "Gabriel Caruso Novaes Tudella"
    },
    {
      "affiliations": [
        "Medical University of Silesia, Katowice, Silesian Voivodeship, Poland"
      ],
      "name": "Paweł Łajczak"
    },
    {
      "affiliations": [
        "Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil"
      ],
      "name": "Guilherme Gonzaga de Menezes Souza"
    },
    {
      "affiliations": [
        "Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil"
      ],
      "name": "Pedro  Sandes Pereira"
    },
    {
      "affiliations": [
        "Medical Science Center, Universidade Federal da Paraíba, João Pessoa, PB, Brazil"
      ],
      "name": "João Vitor Andrade Fernandes"
    },
    {
      "affiliations": [
        "State University of Piauí, Teresina, PI, Brazil"
      ],
      "name": "Izabely dos reis de Paula"
    },
    {
      "affiliations": [
        "University of Santo Amaro, Sao Paulo, Brazil"
      ],
      "name": "Julia Sader Neves Ferreira"
    },
    {
      "affiliations": [
        "Federal University of Pará Institute of Medical Sciences, Belém, Brazil"
      ],
      "name": "Laiana Neves Cordeiro Cavalcanti"
    },
    {
      "affiliations": [
        "University of Pará State, Belém, Brazil"
      ],
      "name": "Leonardo Bastos Santos"
    },
    {
      "affiliations": [
        "Neurosurgical Service, BIDMC, Boston, Massachusetts, USA"
      ],
      "name": "Christopher S Ogilvy"
    },
    {
      "affiliations": [
        "Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St Michael’s Hospital, Toronto, Ontario, Canada",
        "Neuroendovascular Program, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Adam A Dmytriw"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, Île-de-France, France"
      ],
      "name": "Frédéric Clarençon"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Hospital Henri Mondor, Créteil, Île-de-France, France"
      ],
      "name": "Luca Scarcia"
    }
  ],
  "title": "Management of infectious intracranial aneurysms: a systematic review and network meta-analysis",
  "uid": "291ad479-5116-5928-899a-7f68ce3cf736"
}