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

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.

Clinical outcomes of pipeline embolization devices with shield technology for treating intracranial aneurysms

“…In a meta-analysis evaluating the efficacy of FDs in posterior compared to anterior circulation aneurysms, posterior circulation aneurysms were found to be effectively treated using FDs, with comparable occlusion rates to those in anterior circulation aneurysms. However, the risk of periprocedural complications was not negligible ( 41 ). Early studies have reported higher complication rates associated with the use of FDs in the posterior circulation ( 42 – 45 ).…”

Microsurgical Clipping of Unruptured Anterior Circulation Aneurysms—A Global Multicenter Investigation of Perioperative Outcomes

“…6 For instance, aneurysms of the posterior circulation as a complication-prone subgroup are now most commonly treated by endovascular procedures. 7,8 However, surgical clipping continues to be of great importance in the treatment of incidental aneurysms, especially in complex, irregular, wide-neck aneurysms. A major advantage of microsurgical aneurysm repair is a high and long-lasting occlusion rate 9 and the lack of need for subsequent anticoagulation, often necessary after placement of endovascular devices.…”

“…6 For instance, aneurysms of the posterior circulation as a complication-prone subgroup are now most commonly treated by endovascular procedures. 7,8…”