Journal article
Flow diversion for posterior circulation intracranial aneurysms: a systematic review and meta-analysis
Journal of neurointerventional surgery, Vol.18(3), pp.773-781
03/2026
DOI: 10.1136/jnis-2025-023190
PMID: 40268406
Abstract
Posterior circulation (PC) aneurysms are associated with a higher risk of rupture. Flow diverters (FDs) are widely used for carotid intracranial aneurysms, but their role in PC aneurysms is less established. This meta-analysis examines the available literature on the safety and effectiveness of FDs for PC aneurysms.
We conducted a systematic search from database inception until October 2024. The primary effectiveness outcome was complete occlusion rate defined by the Raymond-Roy and/or O'Kelly-Marotta scales. Primary safety outcomes included thromboembolic event rates following implantation. Secondary outcomes included procedure-related mortality, good functional outcome (GFO), and retreatment. Pool estimates were calculated using a random-effect model. Subgroup analysis based on morphology and study design was also conducted.
A total of 42 studies met our inclusion criteria. A total of 1698 patients were treated with FDs for 1760 PC aneurysms. Among these cases, 47.6% were in the vertebral artery. Our pooled overall analysis of complete occlusion rates was 72.73% (P<0.0001; I
=67.2%), and the pooled thromboembolic events rate following implantation was 11.70% (P<0.0046; I
=70.5%). Additionally, the pooled mortality rate was 8.07% (P<0.0001; I
=61.5%), the retreatment rate was 6.59% (P<0.4260; I
=1%), and the pooled GFO rate was 83.99% (P<0.0001; I
=76%). Subgroup analysis revealed that fusiform-dolichoectatic had a complete occlusion rate of 48.29% (P<0.3223; I
=11.7%).
FDs for PC aneurysms achieve generally adequate occlusion rates, except in dolichoectatic-fusiform subtypes. Despite achieving adequate occlusion rates, FD use was associated with higher thromboembolic events, mortality, and retreatment rates, which necessitates careful patient selection.
Details
- Title: Subtitle
- Flow diversion for posterior circulation intracranial aneurysms: a systematic review and meta-analysis
- Creators
- Anderson Brito - Neurology, University of Iowa Health Care, Iowa City, Iowa, USALeonardo Cruz-Criollo - University of IowaMilagros Galecio-Castillo - University of Iowa, NeurologyJorge Cespedes - University of Iowa, NeurologyMario Zanaty - University of IowaEdgar A Samaniego - Neurology, Neurosurgery, and Radiology, University of Iowa Health Care, Iowa City, Iowa, USANashwa Abdelhakim - Neurology, University of Iowa Health Care, Iowa City, Iowa, USAAjay K Wakhloo - Tufts Medical CenterRicardo A Hanel - Baptist Medical Center JacksonvilleSantiago Ortega-Gutierrez - Neurology, Neurosurgery, and Radiology, University of Iowa Health Care, Iowa City, Iowa, USA santy-ortega@uiowa.edu
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery, Vol.18(3), pp.773-781
- DOI
- 10.1136/jnis-2025-023190
- PMID
- 40268406
- NLM abbreviation
- J Neurointerv Surg
- ISSN
- 1759-8486
- eISSN
- 1759-8486
- Publisher
- Society of NeuroInterventional Surgery; LONDON
- Language
- English
- Electronic publication date
- 04/23/2025
- Date published
- 03/2026
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984813165702771
Metrics
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