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Flow-diverter devices in the treatment of intracranial aneurysms: A meta-analysis and systematic review

Xianli Lv¹, Hongchao Yang¹, Peng Liu¹

¹Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, People's Republic of China.

The Neuroradiology Journal

|February 4, 2016

Insights

Flow-diverter stenting for intracranial aneurysms shows limitations and risks. Specific aneurysm types and locations, particularly in the posterior circulation, are associated with higher complication rates, impacting safety and efficacy.

Area of Science:

Neurosurgery
Interventional Radiology
Vascular Surgery

Background:

Intracranial aneurysms pose significant risks, necessitating advanced treatment options.
Flow-diverter stenting has emerged as a minimally invasive technique for treating complex intracranial aneurysms.
Understanding the safety and efficacy profile of this technology is crucial for clinical decision-making.

Purpose of the Study:

To evaluate the overall limitations, safety, and efficacy of flow-diverter stenting in treating intracranial aneurysms.
To identify specific risk factors associated with flow-diverter stenting procedures.
To provide a comprehensive analysis of outcomes in a large patient cohort.

Main Methods:

A systematic meta-analysis was conducted, reviewing studies published between January 2009 and September 2014.
Keywords "flow diverter" and "intracranial aneurysms" were used for literature search, supplemented by reference list reviews.
Data extraction included patient demographics, technical/clinical complications, morbidity/mortality, and aneurysm occlusion rates, analyzed using a fixed-effect model.

Main Results:

The analysis included 29 studies encompassing 1524 patients with follow-up ranging from 3 to 62 months.
The overall technical failure rate was 9.3%, with procedure-related complications occurring in 14% of cases.
Fusiform, dissecting, or circumferential aneurysms, along with posterior circulation and peripheral locations, were identified as significant risk factors for complications, morbidity, and mortality.

Conclusions:

Flow-diverter stenting for intracranial aneurysms is associated with specific risks.
Aneurysm morphology (fusiform, dissecting, circumferential) and location (posterior circulation, peripheral) significantly increase the risk of procedure-related complications.
These findings highlight the importance of careful patient selection and procedural planning to optimize outcomes.

Read full analysis

Abstract

Objective:

The purpose of this report was to discuss the overall limitations, safety and efficacy of flow-diverter stenting for intracranial aneurysms.

Methods:

The authors performed a meta-analysis from January 2009 to September 2014 using the terms "flow diverter" and "intracranial aneurysms." Additional studies were identified through references in each reviewed article. Data extraction, performed independently by the authors, included demographic data, technical and clinical complications, morbidity and mortality, aneurismal occlusion rates related to flow-diverter devices. The analysis was performed using a fixed effect.

Results:

Twenty-nine studies with 1524 patients and three to 62 months of follow-up were identified for analysis. The overall technical failure and complication rate was 9.3% (95% CI 6%-12.6%). The rate of procedure-related complication was 14% (95% CI 10.2%-17.9%) and 6.6% (95% CI 4%-9.1%) for morbidity and mortality. Fusiform, dissecting and circumferential aneurysm (OR 3.10, 95% CI 0.93-10.37) were significant risk factors for technical failure and complication. Posterior circulation location (OR 4.03, 95% CI 2.45-6.61), peripheral location (OR 2.74, 95% CI 1.52-4.94) and fusiform, dissecting and circumferential aneurysm (OR 1.95, 95% CI 1.15-3.30) were statistically significant risk factors for procedure-related complications. Posterior circulation location (OR 4.39, 95% CI 2.44-7.90) and peripheral location (OR 3.64, 95% CI 1.74-7.62) were statistically significant risk factors for morbidity and mortality.

Conclusions:

Fusiform, dissecting and circumferential aneurysm, posterior circulation and peripheral locations have greater procedure-related complications.

Keywords:

Intracranial aneurysm endovascular treatment flow-diverter stenting

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