[Systematic review of complications for proper informed consent: (10) endovascular therapy for unruptured intracranial aneurysms].

Less invasive neuroimaging modalities have recently resulted in the more frequent detection of unruptured intracranial aneurysms(UIAs). Therefore, more patients, than ever before, with UIAs are currently being referred to neurosurgeons, who then must inform their patients of the optimal management possibilities. Endovascular therapy has become an important and well-known alternative to surgical clipping. However, as many neurosurgeons are not yet familiar enough with endovascular therapy, it is difficult for them to clearly explain the risks to their patients. The purpose of this systematic review is to disclose the risks of endovascular therapy for UIAs, which should be helpful to neurosurgeons, so that they can provide the appropriate information to their patients in order to obtain informed consent. In the present study, the overall morbidity and mortality rate of endovascular therapy of UIAs was 4.4% and 0.7%, respectively. Elderly patients had a higher risk of morbidity and mortality than did younger patients. The average risks of thromboembolic events and intraprocedural aneurysm rupture were 6.6% and 1.7%, respectively. Although posttreatment bleeding was extremely rare, patients with incompletely occluded large UIAs were more at risk. Furthermore, large UIAs more frequently required retreatment than did smaller ones. Other complications(e.g., puncture site complications, side effects due to the contrast medium, radiation injuries, heparin-induced thrombocytopenia, perianeurysmal edema, hydrocephalus, and aseptic meningitis)must also be explained to the patient.