Treatment of posterior circulation non-saccular aneurysms with flow diversion versus stent-assisted coiling: a systematic review and meta-analysis

Abstract

<jats:p>Treatment of non-saccular aneurysms of the posterior circulation poses a great challenge with unpredictable outcomes due to the absence of a true aneurysm neck and the presence of perforating vessels. In this article, we aim to compare endovascular treatment of unruptured posterior circulation non-saccular aneurysms with stent-assisted coiling (SAC) and flow diversion (FD) in terms of occlusion rate and clinical outcomes. A systematic search of electronic databases from inception to August 2019 identified 484 articles for screening. After proper inclusion/exclusion criteria, 15 articles were included and data were extracted and analyzed using meta-analysis of proportions. The pooled cohort consisted of 430 aneurysms: 128 (29.7%) treated with SAC in 5 studies and 302 (70.3%) treated with FD in 11 studies. Complete/near-complete occlusion was achieved in 83% after FD (95% CI 0.75 to 0.90; I<jats:sup>2</jats:sup>=45%) and 84% after SAC (95% CI 0.72 to 0.91; I<jats:sup>2</jats:sup>=22%), with no significant difference between techniques (p=0.95). Periprocedural complications were observed in 18% after FD (95% CI 0.14 to 0.23; I<jats:sup>2</jats:sup>=0%) and 6% after SAC (95% CI 0.02 to 0.13; I<jats:sup>2</jats:sup>=0%); the subgroup analysis was statistically significant (p=0.008). Furthermore, no statistically significant difference was observed in favorable clinical outcomes between groups. These results suggest similar efficacy in occlusion rate and favorable clinical outcome for posterior circulation non-saccular aneurysms treated with SAC and FD. Stroke was the most common complication regardless of treatment modality, and a lower periprocedural complication rate was noted with SAC. Further studies are needed with the primary focus of reducing the risk of stroke with either modality.</jats:p>

Endovascular Treatment of Large or Giant Basilar Artery Aneurysms Using the Pipeline Embolization Device: Complications and Outcomes

“…The most common complication in our study was ischemia, including four perioperative perforator strokes, one perioperative embolic stroke, and four cases of in-stent thrombosis owing to discontinuation of antiplatelet therapy. This result was also similar to a previously reported meta-analysis on FD treatment of posterior circulation non-saccular aneurysms ( 31 ). Circumferential involvement of the vessel wall and presence of vital perforating arteries are frequently encountered problems when treating large or giant BA aneurysms.…”

Endovascular Management of Vertebrobasilar Trunk Artery Large Aneurysms: Complications and Long-Term Results

“…Chalouhi et al (18) analyzed the complications of 334 coiled large/giant aneurysms and found a trend that posterior circulation aneurysms could predict complications and recurrence. In this study, we demonstrated an overall complication rate of 16.1% (10/62), which was similar to the complication rates of overall posterior circulation aneurysms in published studies (7,(17)(18)(19)(20).…”

“…Surgery is the essential management in those cases, including open surgery or endovascular procedures (3,5). Endovascular management including coiling, stent-assisted coiling, and flow diversion (FD) has certain advantages compared to open surgery, but VBTLA is still associated with an increased complication risk as compared to aneurysms located in anterior circulation, due to their location, surgical accessibility, pathological features, and relation to perforating branches of vertebrobasilar artery (6)(7)(8). However, there are limited reports on the endovascular management of VBTLAs and the long-term clinical prognosis still needs to be further confirmed.…”

Absence of pontine perforators in vertebrobasilar dolichoectasia on ultra-high resolution cone-beam computed tomography

“… 25 Nevertheless, in a recent meta-analysis the overall complication rate was higher for FDs than with stent-assisted coiling (18% vs 6%), including higher chance for stroke (13% vs 5%, p=0.04). 26 The safety and efficacy of endovascular treatment of patients with VBDE is dependent on the size of the lesion, the patient’s overall clinical condition, and the treatment modality used.…”