Efficacy and safety of flow diverters in posterior circulation aneurysms and comparison with their efficacy in anterior circulation aneurysms: A systematic review and meta-analysis

Abstract

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.

Fungal symptomatic intracranial aneurysm treated with a flow diverting stent: A case report

“…In the present case, although the aneurysm remained even one year after flow-diverting stent placement, the aneurysm decreased in size and remained unruptured. Predictive factors were reported, such as older age (>70 years),[ 12 , 19 ] aneurysm with mass effect, aneurysm location other than vertebral artery,[ 1 ] and fusiform morphology. [ 19 ] These factors were consistent with the present case and seemed to be the cause of incomplete occlusion.…”

When microsurgery becomes the only lifesaving resource: An institutional experience treating patients from low-income backgrounds affected by posterior circulation brain aneurysms

“…Shifting to ow-diverters, they are currently gaining signi cant attention, but results for aneurysms of the posterior circulation are still not completely encouraging. [29][30][31] For complex aneurysms, when conventional strategies are unsuitable, considering the outcomes, open surgery revascularizations are an adequate option for skilled neurosurgeons, 32 mainly in limited-resource countries. 15 When comparing endovascular to surgical approaches for PICA aneurysms, Saal-Zapata et al demonstrated that the literature, despite extensive, carries a serious risk of bias.…”

Clinical outcomes of pipeline embolization devices with shield technology for treating intracranial aneurysms

“…In a meta-analysis evaluating the efficacy of FDs in posterior compared to anterior circulation aneurysms, posterior circulation aneurysms were found to be effectively treated using FDs, with comparable occlusion rates to those in anterior circulation aneurysms. However, the risk of periprocedural complications was not negligible ( 41 ). Early studies have reported higher complication rates associated with the use of FDs in the posterior circulation ( 42 – 45 ).…”