Flow Diversion in Ruptured Intracranial Aneurysms: A Meta-Analysis

Area of Science:

• Neurosurgery
• Endovascular Therapy
• Cerebrovascular Disease

Background:

• Flow diversion is an established treatment for unruptured intracranial aneurysms.
• Its efficacy in ruptured aneurysms remains less clear.

Purpose of the Study:

• To estimate angiographic occlusion and clinical outcome rates in ruptured intracranial aneurysms treated with flow-diverting devices.

Main Methods:

• Systematic review of multiple databases (Ovid MEDLINE, PubMed, Cochrane, EMBASE) up to December 2015.
• Inclusion of 20 articles with sufficient patient and outcome data.
• Analysis of clinical, radiologic, and procedural details using Fisher exact test.

Main Results:

• Complete aneurysm occlusion achieved in 90% of patients.
• Favorable clinical outcome attained in 81% of patients.
• Aneurysm size >7 mm correlated with poorer clinical outcomes (P=.027); size >2 cm associated with increased rerupture risk (P<.001).

Conclusions:

• Flow diversion may offer high occlusion and good clinical outcomes for carefully selected ruptured intracranial aneurysm patients.
• Aneurysm size is a critical factor influencing treatment risk, particularly rerupture risk for larger aneurysms (>2 cm).
• While not first-line, flow diversion is a viable option in specific cases.