Flow diverter versus stent-assisted coiling treatment for managing dissecting intracranial aneurysms: A systematic review and meta-analysis.
Leonardo B O Brenner, Milena Zadra Prestes, Cid Soares et al.
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In 30 seconds
This systematic review and meta-analysis compared flow diverters (FDs) with stent-assisted coiling (SAC) for dissecting intracranial aneurysms, drawing on 10 studies with 195 FD-treated and 222 SAC-treated patients. SAC was associated with higher postoperative complete aneurysm occlusion (OR 0.03; 95% CI 0.01-0.08). At angiographic follow-up, complete occlusion did not differ significantly between groups. Mortality, complications, good clinical outcomes, and recurrence also showed no significant between-group differences. FD retreatment was numerically lower, but the difference was not statistically significant.
Key findings
- SAC had higher postoperative complete aneurysm occlusion than FD (OR 0.03; 95% CI 0.01-0.08).
- Follow-up complete occlusion did not differ significantly between FD and SAC (OR 1.18; 95% CI 0.35-3.99).
- FD retreatment was numerically lower than SAC, without statistical significance (OR 0.35; 95% CI 0.11-1.10).
- No significant differences were found in mortality, complications, good clinical outcomes, or recurrence.
Why it matters
The findings suggest that the early angiographic advantage associated with SAC may not persist at follow-up, while measured clinical outcomes and complications were similar. This comparison can inform discussion of reconstructive endovascular options, but the evidence does not establish overall superiority of either approach.
What to keep in mind
The evidence came from 10 studies rather than randomized trials; the authors call for larger, prospective, multicenter randomized studies.