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Review
. 2022 Mar 15;12(3):394.
doi: 10.3390/brainsci12030394.

Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW)

Michelle F M Ten Brinck  1 , Viktoria E Shimanskaya  1 , René Aquarius  1 , Ronald H M A Bartels  1 , Frederick J A Meijer  2 , Petra C Koopmans  3 , Guido de Jong  1 , Ajay K Wakhloo  4 , Joost de Vries  1 , Hieronymus D Boogaarts  1
Affiliations
Review

Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW)

Michelle F M Ten Brinck et al. Brain Sci. .

Abstract

Background: patients with a subarachnoid hemorrhage (SAH) might need a flow diverter (FD) placement for complex acutely ruptured intracranial aneurysms (IAs). We conducted a meta-analysis and developed a prediction model to estimate the favorable clinical outcome after the FD treatment in acutely ruptured IAs.

Methods: a systematic literature search was performed from 2010 to January 2021 in PubMed and Embase databases. Studies with more than five patients treated with FDs within fifteen days were included. In total, 1157 studies were identified. The primary outcome measure was the favorable clinical outcome (mRS 0-2). Secondary outcome measures were complete occlusion rates, aneurysm rebleeding, permanent neurologic deficit caused by procedure-related complications, and all-cause mortality. A prediction model was constructed using individual patient-level data.

Results: 26 retrospective studies with 357 patients and 368 aneurysms were included. The pooled rates of the favorable clinical outcome, mortality, and complete aneurysm occlusion were 73.7% (95% CI 64.7-81.0), 17.1% (95% CI 13.3-21.8), and 85.6% (95% CI 80.4-89.6), respectively. Rebleeding occurred in 3% of aneurysms (11/368). The c-statistic of the final model was 0.83 (95% CI 0.76-0.89). All the studies provided a very low quality of evidence.

Conclusions: FD treatment can be considered for complex ruptured IAs. Despite high complication rates, the pooled clinical outcomes seem favorable. The prediction model needs to be validated by larger prospective studies before clinical application.

Keywords: endovascular techniques; flow diverter; intracranial aneurysm; posterior communication artery.

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Conflict of interest statement

J.d.V., H.D.B. and A.K.W. have consultancy relationships to Stryker Neurovascular. The other authors have no conflict of interest.

Figures

Figure 1
Figure 1
Meta-analysis of the favorable clinical outcome rate.
Figure 2
Figure 2
Meta-analysis of all-cause mortality.
Figure 3
Figure 3
Meta-analysis of the complete occlusion rate.
See this image and copyright information in PMC

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