Flow diverter versus stent-assisted coiling treatment for managing dissecting intracranial aneurysms: A systematic review and meta-analysis

Background: Dissecting intracranial aneurysms (DIAs) have been treated through endovascular reconstructive manners, such as flow diverters (FDs) and stent-assisted coiling (SAC). Notably, no robust evidence has compared both approaches. Hence, the authors conducted a meta-analysis to compare their outcomes.

Methods: PubMed, Embase and Web of Science were searched for studies employing SAC and FD treatment for DIAs. The following outcomes were considered for extraction: procedure-related mortality, total mortality, postoperative and follow-up complete aneurysm occlusion, complications, good clinical outcomes, recurrence, and retreatment. Odds ratio (OR) with random effects was employed for statistical comparison.

Results: The meta-analysis included 10 studies. A total of 195 and 222 patients were included in the FD and the SAC group, respectively. Stent-assisted coiling had higher postoperative complete aneurysm occlusion rates (OR 0.03; 95% CI 0.01-0.08). Flow diverter retreatment rate was lower, but without statistical significance (OR 0.35; 95% CI 0.11-1.10). No significant differences were found in follow-up complete aneurysm occlusion (OR 1.18; 95% CI 0.35-3.99); total mortality (OR 0.44; 95% CI 0.09-2.08); intraoperative complications (OR 0.30; 95% CI 0.06-1.45); postoperative complication (OR 0.77; 95% CI 0.35-1.70); good clinical outcomes (OR 0.97; 95% CI 0.43-2.20); and recurrence (OR 0.38; 95% CI 0.13-1.10) between the two groups.

Conclusion: Stent-assisted coiling shows higher postoperative complete aneurysmal occlusion rates, but both techniques achieve similar rates in angiographic follow-up. Flow diverter has lower, but not statistically significant, retreatment rates than SAC. Both techniques have similar complication rates. Future randomized, multicenter, and prospective studies with larger sample sizes are needed for more conclusive findings.