The Safety and Efficacy of Flow Diversion versus Conventional Endovascular Treatment for Intracranial Aneurysms: A Meta-analysis of Real-world Cohort Studies from the Past 10 Years

BACKGROUND: Although the flow diverter has advantages in the treatment of intracranial aneurysms, pooled studies that directly compare it with conventional endovascular treatments are rare.

PURPOSE: Our aim was to compare the safety and efficacy of flow-diverter and conventional endovascular treatments in intracranial aneurysms.

DATA SOURCES: We performed a comprehensive search of the literature using PubMed, EMBASE, and the Cochrane Database.

STUDY SELECTION: We included only studies that directly compared the angiographic and clinical outcomes of flow-diverter and conventional endovascular treatments.

DATA ANALYSIS: Random effects or fixed effects meta-analysis was used to pool the cumulative rate of short- and long-term angiographic and clinical outcomes.

DATA SYNTHESIS: Eighteen studies with 1001 patients with flow diverters and 1133 patients with conventional endovascular treatments were included; 1015 and 1201 aneurysm procedures were performed, respectively. The flow-diverter group had aneurysms of a larger size (standard mean difference, 0.22; 95% CI, 0.03–0.41; P = .026). There was a higher risk of complications in the flow-diverter group compared with the conventional endovascular group (OR, 1.4; 95% CI, 1.01–1.96; P = .045) during procedures. The follow-up angiographic results of flow-diverter treatment indicated a higher rate of complete occlusion (OR, 2.55; 95% CI, 1.70–3.83; P < .001) and lower rates of recurrence (OR, 0.24; 95% CI, 0.12–0.46; P < .001) and retreatment (OR, 0.31; 95% CI, 0.21–0.47; P < .001).

LIMITATIONS: Limitations include a retrospective, observational design in some studies, high heterogeneity, and selection bias.

CONCLUSIONS: Compared with the conventional endovascular treatments, the placement of a flow diverter may lead to more procedure-related complications, but there is no difference in safety, and it is more effective in the long term.