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Meta-Analysis
. 2021 Oct;27(5):609-621.
doi: 10.1177/15910199211003017. Epub 2021 Mar 22.

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

Mohamed Abdel-Tawab  1 , Ahmed K Abdeltawab  2 , Mohamed Abdelmonem  2 , Mahmoud A Moubark  1 , Mohamed Ah Taha  3 , Abdalla Morsy  4 , Ahmed Awad Bessar  5   6 , Mahmoud Ahmed Ebada  5   7
Affiliations
Meta-Analysis

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

Mohamed Abdel-Tawab et al. Interv Neuroradiol. 2021 Oct.

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.

Keywords: Flow-diverter device; endovascular treatment; pipeline embolization device; posterior circulation aneurysms.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram of the study selection process.
Figure 2.
Figure 2.
Aneurysmal occlusion rates.
Figure 3.
Figure 3.
Subgroup analysis of aneurysmal occlusion rates with aneurysms stratified by flow-diverter stent device used.
Figure 4.
Figure 4.
Retreatment rates.
Figure 5.
Figure 5.
Adjunctive coiling rates.
Figure 6.
Figure 6.
Comparison of angiographic outcomes between anterior and posterior circulation aneurysms.
Figure 7.
Figure 7.
Comparison of angiographic outcomes results after leave-one-out sensitivity analysis.
Figure 8.
Figure 8.
Intraparenchymal hemorrhage rates.
Figure 9.
Figure 9.
Ischemia rates.
Figure 10.
Figure 10.
Postoperative aneurysmal rupture rates.
Figure 11.
Figure 11.
Perforator artery occlusion rates.
Figure 12.
Figure 12.
Procedure-related mortality.
Figure 13.
Figure 13.
Procedure-related neurological morbidity.
See this image and copyright information in PMC

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