Safety and Efficacy of Flow Diverter Treatment for Aneurysm in Small Cerebral Vessels: A Systematic Review and Meta-analysis.

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Safety and Efficacy of Flow Diverter Treatment for Aneurysm in Small Cerebral Vessels: A Systematic Review and Meta-analysis.

World Neurosurg. 2018 Apr 10;:

Authors: Yan Y, Zhu D, Tang H, Huang Q

Abstract
PURPOSE: To clarify the safety and efficacy of flow diverter (FD) treatment for aneurysm in small cerebral vessels, we conducted a systematic review of the literature analyzing perioperative and long-term clinical and angiographic outcomes.
METHODS: A comprehensive review of the up-to-date literature for studies with ≥10 patients related to FD treatment of small vessel aneurysms published was performed. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical procedural success, perioperative mortality, perioperative stroke, procedure-related morbidity and mortality, all complications, long-term mortality, and overall good outcome.
RESULTS: We included 26 non-comparative studies with 572 target aneurysms. The technical procedural success rate was 96% (95% CI = 0.93-1.00). At final follow-up, the complete occlusion rate was 70% (95% CI = 0.64-0.76). All causes morbidity rate was 20% (95% CI = 0.14-0.25). Procedure-related morbidity and mortality rates were 9% (95% CI = 0.07-0.12) and 4% (95% CI = 0.00-0.08), respectively. Overall long-term good outcome rate was 96% (95% CI = 0.93-0.99). In the three subgroup analyses, complete occlusion rate of saccular aneurysms was lower than that of nonsaccular aneurysms (55% versus 73%, respectively; OR = 0.40, 95% CI = 0.17-0.98, P = 0.04). The procedure-related morbidity rate and the good outcome rate were not significantly different in this subgroup. In the other two subgroups in which we compared anterior circulation aneurysms with posterior circulation aneurysms and single FD strategy with overlapped FD strategy, the rates were also not significantly different.
CONCLUSION: Our meta-analysis demonstrated that FD treatment of small vessel aneurysms is technically feasible and effective with a high rate of complete occlusion. Although the comorbidities of patients cannot be neglected, the FD approach was associated with an acceptable rate of procedure-related morbidity and a satisfactory rate of overall good outcome.

PMID: 29653275 [PubMed - as supplied by publisher]

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