Flow diverter treatment of posterior circulation aneurysms. A meta-analysis

Abstract

IntroductionTreatment of complex anterior circulation aneurysms with flow diverters (FDs) has become common practice in neurovascular centers. However, this treatment method for posterior circulation aneurysms (PCAs) still remains controversial.MethodsThrough searches for reports on the treatment of PCAs with FDs, we conducted a systematic review of the literature on its clinical efficacy and safety using random-effect binomial meta-analysis.ResultsWe included 14 studies, which reported on a total of 225 PCAs in 220 patients. Procedure-related good outcome rate was 79 % (95 % confidence interval (CI), 72–84), with significantly lower odds among patients with ruptured aneurysms and basilar artery aneurysms. Procedure-related mortality rate was 15 % (95 % CI 10–21), with significantly higher rates among patients with giant aneurysms and basilar artery aneurysms. The rate of complete aneurysm occlusion at 6-month digital subtraction angiography (DSA) was 84 %. Ischemic stroke rate was 11 %. Perforator infarction rate was 7 %. Postoperative subarachnoid hemorrhage (SAH) rate was 3 %. Intraparenchymal hemorrhage (IPH) rate was 4 %.ConclusionsFlow diverter treatment of PCAs is an effective method, which provides a high rate of complete occlusion at 6-month DSA. However, compared with anterior circulation aneurysms, patients with PCAs are at significantly higher risk of mortality, ischemic stroke and perforator infarction. Our findings indicate that, in most clinical centers, flow diverter treatment of PCAs should be conducted in carefully selected patients with poor natural history and no optimal treatment strategy. For ruptured and giant basilar artery aneurysms, there is still no good treatment option.

Safety and efficacy of flow re-direction endoluminal device (FRED) in the treatment of cerebral aneurysms: a single center experience

“…As reported in a recent meta-analysis, patients harboring PC aneurysms treated by FDD are at significantly higher risk of mortality, ischemic stroke, and perforator infarctions [30]. Thus, in the PC, the occlusion with the FRED should probably be delayed; besides, the lack of mortality in all the analyzed series is promising.…”

Surpass Flow Diverter for Treatment of Posterior Circulation Aneurysms

“…Any differences might be explained by the higher rates of giant and fusiform aneurysms in our patient cohort, with 33% versus 23% and 77% versus 66%, respectively. 5 Our study has various inherent limitations. It was designed as an international multicenter study in which patient selection was heterogeneous.…”

“…A recent meta-analysis on flow-diverter treatment of posterior circulation aneurysms, including 220 patients with 225 posterior circulation aneurysms, reported morbidity and mortality rates of 6% and 15%, respectively. 5 The morbidity and mortality rates reported in the underlying studies ranged from 0% to 71% and 0% to 57%, respectively. The variability in outcomes clearly reflects the heterogeneity of the underlying pathology.…”

“…[2][3][4] A recent meta-analysis identified 14 studies, which reported on 225 posterior circulation aneurysms treated with FDs in 220 patients. 5 The procedure-related good outcome rate was 79% (95% confidence interval, 72%-84%), and the procedure-related mortality rate was 15% (95% CI, 10%-21%). Most studies in-cluded only a small number of patients (median, 9.5; range, 5-55), and most of these patients (155/220) were treated with the Pipeline Embolization Device (Covidien, Irvine, California).…”

In-stent Stenosis after p64 Flow Diverter Treatment

“…The meta-analysis of Wang et al. [7] focused exclusively on the use of flow diverters in the posterior circulation. In this scenario procedure related mortality was 15% and ischemic stroke rate 11%.…”