Flow Diversion for Anterior Communicating Artery Aneurysms: Systematic Review and Meta-Analysis

Anterior communicating artery (ACoA) aneurysms are associated with a higher risk of rupture. Flow diverters are considered a first-line treatment for intracranial aneurysms. However, the safety and efficacy of ACoA aneurysms are less established. This systematic review and meta-analysis aimed to evaluate the safety and effectiveness of flow diverters for ACoA aneurysms.

We conducted a systematic search from inception until June 2025. The primary effectiveness outcome was the complete occlusion rate at last follow-up, defined by the Raymond-Roy or O'Kelly-Marotta scales, and the primary safety outcome was mortality. Secondary safety outcomes included good functional outcome and major and minor neurological complications. Pooled estimates were calculated using a random-effects model. Subgroup analysis was performed based on follow-up time.

Fifteen studies were included (involving 350 patients with 358 ACoA aneurysms). The complete occlusion rate at last follow-up was 84.29% (95% CI, 79.36-88.22; P=0.95; I ²=0%). The mortality rate was 0.86% (95% CI, 0.28-2.62; P=0.98; I ²=0%). Good functional outcome was 91.15% (95% CI, 73.32-97.48; P=0.84; I ²=0%). Major and minor neurological complications were 2.74% (95% CI, 1.38-5.38; P=0.97; I ²=0%) and 10.57% (95% CI, 6.17-17.53; P=0.13; I ²=32.8%), respectively. Subgroup analysis revealed no significant differences in the complete occlusion rate between follow-up times (overall pooled rate for follow-up ≤12 months was 85.92% compared with 83.68% for follow-up >12 months).

Our results suggest that flow diverters could represent a potential treatment option for ACoA aneurysms, given the observed complete occlusion rate at last follow-up. However, larger prospective trials are required to further evaluate these findings.