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Meta-Analysis
. 2023 Sep;15(9):898-902.
doi: 10.1136/jnis-2022-019240. Epub 2022 Sep 23.

Long-term outcomes of flow diversion for unruptured intracranial aneurysms: a systematic review and meta-analysis

Mostafa A Shehata  1 , Mohamed K Ibrahim  2 , Sherief Ghozy  2 , Cem Bilgin  2 , Mohamed Sobhi Jabal  2 , Ramanathan Kadirvel  2 , David F Kallmes  2
Affiliations
Meta-Analysis

Long-term outcomes of flow diversion for unruptured intracranial aneurysms: a systematic review and meta-analysis

Mostafa A Shehata et al. J Neurointerv Surg. 2023 Sep.

Abstract

Background: Flow diverters have been widely used in clinical practice for more than a decade. However, most outcome data are limited to 1 year timepoints. This study aims to offer meta-analysis data on long-term (>1 year) safety and effectiveness results for patients with aneurysms treated with flow diverters.

Methods: PubMed, Web of Science, Embase, and SCOPUS were searched up to February 24, 2022 using the AutoLit platform. We included primary studies assessing the long-term outcomes for flow diverter devices to manage unruptured internal carotid artery aneurysms with a follow-up period of >1 year. The meta-analysis was carried out using Comprehensive Meta-Analysis software (CMA).

Results: Eleven studies were included in the meta-analysis. The pooled occlusion rates after flow diversion treatment for unruptured intracranial brain aneurysms were 77%, 87.4%, 84.5%, 89.4%, 96% for 1 year, 1-2 years, 2 years, 3 years, and 5 years follow-up, respectively. The in-stent stenosis rate was 4.8% and the retreatment rate for the long-term follow-up period was 5%. No delayed rupture of the aneurysm was reported, and there was one case of delayed ischemic stroke. The sensitivity analysis of the prospective studies showed a complete occlusion rate of 83.5% and 85.2% for 1 and 3 years of follow-up, respectively.

Conclusion: Flow diverters are safe and effective in short- and long-term follow-up and rarely cause serious delayed side effects.

Keywords: aneurysm.

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Conflict of interest statement

Competing interests: DFK holds equity in Nested Knowledge, Superior Medical Editors, and Conway Medical, Marblehead Medical; is a consultant for MicroVention, Medtronic, Balt, and Insera Therapeutics; Data Safety Monitoring Board for Vesalio; and receives royalties from Medtronic. RK reports NIH funding (R01 NS076491, R43 NS110114, and R44 NS107111), is a research consultant for Cerenovus, Insera Therapeutics, Marblehead Medical, Microvention, MIVI Neuroscience, Neurogami Medical, and Triticum, and has stock in Neurosigma (money paid to institution).

Figures

Figure 1,
Figure 1,
PRISMA flow chart of the search and screening process
Figure 2,
Figure 2,
Complete Aneurysm Occlusion. A: 1 year follow-up time; B: 1–2 years follow-up time; C: 2 years follow-up time; D: 3 years follow-up time; E: 5 years follow-up time
Figure 3,
Figure 3,
Complete Aneurysm Occlusion, (Prospective studies). A: 1 year follow-up time; B: 3 year follow-up time
Figure 4,
Figure 4,
4A: In-stent Stenosis; Figure 4B, In-stent Stenosis (Prospective studies); Figure 4C, Recurrence; Figure 4D, Retreatment; Figure 4Es, Recurrence (Prospective studies
See this image and copyright information in PMC

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