Purpose We aimed to assess the efficacy and safety of flow-diverter stents (FDs) in the management of posterior circulation cerebral aneurysms and compare FD efficacy between anterior and posterior circulation aneurysms. Methods We searched the PubMed, Scopus, Cochrane, and Web of Science databases for relevant studies through March 2020. Studies assessing FDs for posterior circulation aneurysms that included ≥20 treated aneurysms were included. Moreover, the studies compared FD efficacy between anterior and posterior circulation aneurysms were included. Data regarding angiographic aneurysmal occlusion, procedural complications, mortality, and morbidity were extracted and pooled in a random-effects meta-analysis model. Results Fourteen studies with a total of 659 patients and 676 posterior circulation aneurysms were included. The pooled rate of aneurysmal occlusion at long-term angiographic follow-up was 78% [95% confidence interval (CI), 71–85]. The pooled rates of intraparenchymal hemorrhage, ischemia, and procedure-related mortality and neurological morbidity were 2%, 8%, 7%, and 6%, respectively. Complete occlusion occurred in 82.4% of the posterior circulation aneurysm subgroup and 77.5% of the anterior circulation aneurysm subgroup. The difference was not significant (relative risk 1.01; 95% CI, 0.86–1.19; p = 0.91). Regression analysis showed that elderly patients and females had higher morbidity. Conclusion Posterior circulation aneurysms can be effectively treated with FDs with comparable occlusion rates to those in anterior circulation aneurysms. However, periprocedural complications are not negligible.

Background: In the last decade, flow diverter (FD) devices are one of the widely used endovascular methods in the treatment of intracranial aneurysms. As the frequency of its use is increasing progressively, we thought that studies concerned with the use of FD at specific locations are helpful to clarify the efficacy and safety of FD as a treatment option in cerebral aneurysms. We represent our experiences in the treatment of posterior communicating artery (PCOM) aneurysms by FD devices aiming to assess its angiographic efficacy (complete aneurysm occlusion) and its related complications. This is a retrospective study of 47 patients harboring 47 PCOM aneurysms treated with Pipeline Embolization Device (PED). Acutely ruptured and non-saccular aneurysms were excluded from the study. Short-and mid-term radiological and clinical outcomes were analyzed. Results: Procedure-related complications were observed in five patients (two ischemic events, two transient ischemic attacks (TIA), and one ipsilateral distal hemorrhage) with no procedure-related mortality. Complete aneurysm occlusion was encountered in 87.2%. In multivariable analysis, large-sized aneurysm and incorporated vessels were an independent predictor of non-occlusion (P = 0.026 and P = 0.035 respectively). A favorable clinical outcome (modified Rankin Scale, 0-2) was observed in 45/47 patients (95.7%); the incidence of postoperative complications was an independent predictor of unfavorable clinical outcomes (P = 0.048). Conclusion: PED stent provides a high occlusion rate in the treatment of PCOM aneurysms with good posttreatment clinical outcomes.

Background The treatment of intracranial wide neck aneurysms (WNAs) is usually difficult, hence several endovascular techniques were developed. This study aims to assess the clinical and angiographic imaging outcome of endovascular management of intracranial wide neck aneurysm. Forty patients were referred to the neuro-endovascular unit, at our hospital, each with a wide neck aneurysm. They were assessed regarding clinical presentation, aneurysm size, the character of the aneurysm, and the age and sex of the patient. Post-procedural, clinical, and angiographic outcomes of the patients who underwent endovascular intervention were reviewed. Results In this study, the mean aneurysmal neck was 5.4 ± 1.6 mm (mm). Endovascular intervention was carried out in all 40 patients in the form of simple coiling in 3 patients, double-catheter technique in 5 patients, balloon-assisted coiling (BAC) in 16 patients, stent-assisted coiling (SAC) in 13 patients, and flow diverter (FD) in 3 patients. Regarding clinical outcome, 4 patients had unfavorable outcome (the modified Rankin Scale, mRS > 2) at presentation and 3 patients at discharge. There was no unfavorable clinical outcome at 6- and 12-month follow-ups. Overall angiographic outcome at 1-year follow-up, 37/40 aneurysms (92.5%) had complete occlusion while two aneurysms had neck recurrence and one aneurysm had neck recanalization. Conclusion The current endovascular techniques in the treatment of WNAs are considered effective, feasible, and safe.