Reply:

We appreciate the interest of Drs. Sluzewski and van Rooij in our report (1). The purpose of our meta-analysis was to quantitatively evaluate specific characteristics of perforations complicating aneurysm therapy. The technique of meta-analysis allows for the collection and pooling of data from similar studies to try to answer questions that none of the studies have sufficient sample size to answer alone (2). Our goal was to pool data from all of the available case series that reported aneurysm perforation during endovascular therapy to more precisely determine the risk of this complication. Other than the report by Sluzewski et al (3), the reports used in our meta-analysis did not report data that would allow us to evaluate size of aneurysm as a risk factor for perforation. Therefore, the relationship of aneurysm size to rate of perforation was not amenable to meta-analysis. We did state that small aneurysm size may be associated with an increased risk of perforation (1). Random or accidental displacements of endovascular devices by a few millimeters that are trivial in a large aneurysm might lead to catastrophic rupture in the more confined lumen of a small aneurysm.