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Review
. 2024 Dec 13:15910199241301820.
doi: 10.1177/15910199241301820. Online ahead of print.

Flow diverter versus stent-assisted coiling treatment for managing dissecting intracranial aneurysms: A systematic review and meta-analysis

Leonardo B O Brenner  1 , Milena Zadra Prestes  1 , Cid Soares  2 , Pedro Romeiro  3 , Victor A Gomez  4 , Nicollas Nunes Rabelo  2   5 , Leonardo C Welling  1 , Stefan W Koester  6 , Agostinho C Pinheiro  7 , Sávio Batista  8 , Raphael Bertani  5 , Eberval Gadelha Figueiredo  5 , Daniel Dutra Cavalcanti  9
Affiliations
Review

Flow diverter versus stent-assisted coiling treatment for managing dissecting intracranial aneurysms: A systematic review and meta-analysis

Leonardo B O Brenner et al. Interv Neuroradiol. .

Abstract

BackgroundDissecting intracranial aneurysms (DIAs) have been treated through endovascular reconstructive manners, such as flow diverters (FDs) and stent-assisted coiling (SAC). Notably, no robust evidence has compared both approaches. Hence, the authors conducted a meta-analysis to compare their outcomes.MethodsPubMed, Embase and Web of Science were searched for studies employing SAC and FD treatment for DIAs. The following outcomes were considered for extraction: procedure-related mortality, total mortality, postoperative and follow-up complete aneurysm occlusion, complications, good clinical outcomes, recurrence, and retreatment. Odds ratio (OR) with random effects was employed for statistical comparison.ResultsThe meta-analysis included 10 studies. A total of 195 and 222 patients were included in the FD and the SAC group, respectively. Stent-assisted coiling had higher postoperative complete aneurysm occlusion rates (OR 0.03; 95% CI 0.01-0.08). Flow diverter retreatment rate was lower, but without statistical significance (OR 0.35; 95% CI 0.11-1.10). No significant differences were found in follow-up complete aneurysm occlusion (OR 1.18; 95% CI 0.35-3.99); total mortality (OR 0.44; 95% CI 0.09-2.08); intraoperative complications (OR 0.30; 95% CI 0.06-1.45); postoperative complication (OR 0.77; 95% CI 0.35-1.70); good clinical outcomes (OR 0.97; 95% CI 0.43-2.20); and recurrence (OR 0.38; 95% CI 0.13-1.10) between the two groups.ConclusionStent-assisted coiling shows higher postoperative complete aneurysmal occlusion rates, but both techniques achieve similar rates in angiographic follow-up. Flow diverter has lower, but not statistically significant, retreatment rates than SAC. Both techniques have similar complication rates. Future randomized, multicenter, and prospective studies with larger sample sizes are needed for more conclusive findings.

Keywords: Stent-assisted coiling; aneurysm; coil; dissecting; flow diverter; meta-analysis; systematic review.

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Conflict of interest statement

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.
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram.
Figure 2.
Figure 2.
Traffic-light plot demonstrating the methodological assessment of each study.
Figure 3.
Figure 3.
Summary plot illustrating the overall quality of the literature by each domain.
Figure 4.
Figure 4.
Forest plot illustrating the comparison of postoperative complete aneurysmal occlusion.
Figure 5.
Figure 5.
Forest plot depicting the comparison of follow-up complete aneurysm occlusion.
Figure 6.
Figure 6.
Forest plot demonstrating the comparison of retreatment.
Figure 7.
Figure 7.
Forest plot illustrating the comparison of total mortality.
Figure 8.
Figure 8.
Forest plot depicting the comparison of intraoperative complications.
Figure 9.
Figure 9.
Forest plot illustrating the comparison of postoperative complications.
Figure 10.
Figure 10.
Forest plot illustrating the comparison of ischemic complications.
Figure 11.
Figure 11.
Forest plot illustrating the comparison of hemorrhagic complications.
Figure 12.
Figure 12.
Forest plot demonstrating the comparison of good clinical outcomes.
See this image and copyright information in PMC

References

    1. Bond KM, Krings T, Lanzino Get al. et al. Intracranial dissections: a pictorial review of pathophysiology, imaging features, and natural history. J Neuroradiol 2021; 48: 176–188. - PubMed
    1. Han J, Liu F, Chen J, et al. Periprocedural cerebrovascular complications and 30-day outcomes of endovascular treatment for intracranial vertebral artery dissecting aneurysms. J Neurosurg 2022: 1–9. Published online November 18, 2022. DOI: 10.3171/2022.10.JNS221953. - DOI - PubMed
    1. Oh HS, Bae JW, Hong CE, et al. Stent-assisted coil embolization versus flow-diverting stent in unruptured vertebral artery dissecting aneurysms: efficacy and safety comparison. Neurosurgery 2023; 93: 120–127. - PubMed
    1. Liu P, Li Z, Hu L, et al. Clinical characteristics, endovascular choices, and surgical outcomes of intracranial vertebral artery dissecting aneurysms: a consecutive series of 196 patients. J Neurosurg 2022; 138: 215–222. Published June 3, 2022. - PubMed
    1. Han J, Tong X, Han M, et al. Flow diverters versus stent-assisted coiling in unruptured intracranial vertebral artery dissecting aneurysms. J Neurosurg 2024; 140: 1064–1070. Published online October 13, 2023. - PubMed

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