Endovascular Treatment for Unruptured Mycotic Aneurysms: A Systematic Review and Meta-Analysis

Background: Mycotic aneurysms (MAs) are rare, life-threatening vascular complications of systemic infections that are most commonly associated with endocarditis. While the majority of research has focused on ruptured MAs, the role of endovascular treatment (EVT) in managing unruptured cases remains unclear. Given the limited availability of data specific to unruptured MAs, we conducted a systematic review and meta-analysis to evaluate the outcomes of EVT in this subgroup, with a focus on technical success, follow-up occlusion, complications, functional outcomes, and mortality. Methods: A comprehensive literature search was conducted in PubMed, EMBASE, and Web of Science to identify studies reporting outcomes of EVT in unruptured MAs. Screening and full-text review were performed via Rayyan AI, and data extraction was conducted via Microsoft Excel. We included studies that explicitly reported outcomes for unruptured cases, and a proportional meta-analysis was performed via a random-effects model in R 4.4.2, with publication bias assessed via a funnel plot. Results: A total of eight studies with 43 unruptured mycotic aneurysms met the inclusion criteria. EVT demonstrated excellent procedural success, whereas endovascular procedures achieved universal technical success and complete occlusion at follow-up (both 100%; 95% CI: 95–100%). Complications were rare, occurring in only 4% of the patients (95% CI: 0–17%). The functional outcomes were favorable, with 90% of patients achieving mRS 0 or GOS 5 at follow-up (95% CI: 74–100%), indicating a high likelihood of preserved neurological function posttreatment. No mortality was reported among the unruptured patients (0%, 95% CI: 0–13%), further supporting the safety profile of EVT in this patient population. Conclusion: EVT appears to be a safe and effective treatment for unruptured mycotic aneurysms, with high technical and angiographic success rates, low complication rates, and favorable functional outcomes. However, data on unruptured cases remain scarce, as most of the available literature has focused primarily on ruptured MAs. This underscores the need for larger studies and prospective data collection to better define the role of EVT in managing these rare lesions.