title: Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis.
abstract: OBJECTIVE
  Flow diverters are important tools in the treatment of intracranial aneurysms. However, their impact on aneurysmal occlusion rates, morbidity, mortality, and complication rates is not fully examined.
  
  
  METHODS
  We conducted a systematic review of the literature searching multiple databases for reports on the treatment of intracranial aneurysms with flow-diverter devices. Random effects meta-analysis was used to pool outcomes of aneurysmal occlusion rates at 6 months, and procedure-related morbidity, mortality, and complications across studies.
  
  
  RESULTS
  A total of 29 studies were included in this analysis, including 1451 patients with 1654 aneurysms. Aneurysmal complete occlusion rate was 76% (95% confidence interval [CI], 70%-81%). Procedure-related morbidity and mortality were 5% (95% CI, 4%-7%) and 4% (95% CI, 3%-6%), respectively. The rate of postoperative subarachnoid hemorrhage was 3% (95% CI, 2%-4%). Intraparenchymal hemorrhage rate was 3% (95% CI, 2%-4%). Perforator infarction rate was 3% (95% CI, 1%-5%), with significantly lower odds of perforator infarction among patients with anterior circulation aneurysms compared with those with posterior circulation aneurysms (odds ratio, 0.01; 95% CI, 0.00-0.08; P<0.0001). Ischemic stroke rate was 6% (95% CI, 4%-9%), with significantly lower odds of perforator infarction among patients with anterior circulation aneurysms compared with those with posterior circulation aneurysms (odds ratio, 0.15; 95% CI, 0.08-0.27; P<0.0001).
  
  
  CONCLUSIONS
  This meta-analysis suggests that treatment of intracranial aneurysms with flow-diverter devices is feasible and effective with high complete occlusion rates. However, the risk of procedure-related morbidity and mortality is not negligible. Patients with posterior circulation aneurysms are at higher risk of ischemic stroke, particularly perforator infarction. These findings should be considered when considering the best therapeutic option for intracranial aneurysms.
authors: Department of Neurosurgery, Mayo Clinic, OL 1-115, 200 SW First St, Rochester, MN 55905, USA. brinjikji.waleed@mayo.edu
authors: Waleed
authors: W
authors: Brinjikji
authors: Mohammad H
authors: MH
authors: Murad
authors: Giuseppe
authors: G
authors: Lanzino
authors: Harry J
authors: HJ
authors: Cloft
authors: David F
authors: DF
authors: Kallmes
mesh_terms: D002560:Cerebrovascular Circulation / Q000502:physiology; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome