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Meta-Analysis
. 2023 Sep;15(9):892-897.
doi: 10.1136/jnis-2022-019249. Epub 2022 Aug 2.

Flow diversion for compressive unruptured internal carotid artery aneurysms with neuro-ophthalmological symptoms: a systematic review and meta-analysis

Daniel P O Kaiser  1   2 , Ani Cuberi  3 , Jennifer Linn  1 , Matthias Gawlitza  4   2
Affiliations
Meta-Analysis

Flow diversion for compressive unruptured internal carotid artery aneurysms with neuro-ophthalmological symptoms: a systematic review and meta-analysis

Daniel P O Kaiser et al. J Neurointerv Surg. 2023 Sep.

Abstract

Background: Data on the safety and efficacy of flow diverters (FD) for the treatment of unruptured internal carotid artery (ICA) aneurysms with compressive neuro-ophthalmological symptoms (NOS) are scarce and comprise mainly small case series.

Methods: We performed a search of three databases and included series with ≥10 patients, with unruptured aneurysms of the ICA and NOS, treated with FD. Random-effects analysis of treatment results and safety was performed.

Results: A total of 22 studies reporting on 594 patients were included. Pooled proportions of NOS recovery, improvement, transient and permanent worsening were: 47.4% (95% CI 35.0% to 60.1%); 74.5% (95% CI 67.9% to 80.2%); 7.1% (95% CI 3.3% to 14.7%); and 4.9% (95% CI 3.2% to 7.4%), respectively. Rates of complete recovery and improvement in patients with isolated visual symptoms were 30.6% (95% CI 12.5% to 57.7%) and 56.6% (95% CI 42.3% to 69.9%). Isolated oculomotor symptoms recovered completely in 47.8% (95% CI 29.9% to 66.3%) and improved in 78% (95% CI 69.2% to 84.9%). Morbidity occurred in 5% (95% CI 2.8% to 9%) and mortality in 3.9% (95% CI 2% to 7.5%) of patients. An increased likelihood of symptom improvement was observed when treatment was performed early (<1 month) after symptom onset (OR=11.22, 95% CI 3.9% to 32.5%).

Conclusion: Flow diversion promotes recovery or improvement of compressive symptoms in a large proportion of patients but is associated with significant rates of morbidity and mortality. Transient and permanent NOS worsening is not uncommon. Early treatment is of utmost importance, as it increases the likelihood of symptom improvement more than 10-fold.

Keywords: Aneurysm; Complication; Flow Diverter; Stent.

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Conflict of interest statement

Competing interests: DPOK: Received stents from Phenox for research purposes and funding from the Else Körner Fresenius Center of Digital Health and the Joachim Herz Foundation; has a non-financial research agreement with Brainomix; serves as board member of the German Society of Neuroradiology (DGNR). MG: Consultancy contract with Phenox; proctoring contract with MicroVention; member of the clinical event committee for a study on a flow diverter, sponsored by Microvention; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events by Phenox; received stents from Phenox for research purposes; received funding from the Else Körner Fresenius Center of Digital Health.

Figures

Figure 1
Figure 1
Forest plots for the proportions of complete recovery (A), improvement (B), transient (C), and permanent worsening (D).
Figure 2
Figure 2
Forest plots for the proportions of complete visual recovery (A) and improvement (B), and complete oculomotor recovery (C) and improvement (D).
Figure 3
Figure 3
Forest plots for the proportions of morbidity (A) and mortality (B).
Figure 4
Figure 4
Forest plots for the effect of early (within 1 month) and delayed (>1 month) treatment on symptom improvement.
See this image and copyright information in PMC

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