title: Flow Diversion in Ruptured Intracranial Aneurysms: A Meta-Analysis.
abstract: Flow diversion is now an established technique to treat unruptured intracranial aneurysms not readily amenable to endovascular coil embolization or open microsurgical occlusion. The role of flow-diverting devices in treating ruptured aneurysms is less clear.
  
  
  
  To estimate rates of angiographic occlusion and good clinical outcome in patients with ruptured intracranial aneurysms treated with flow-diverting devices.
  
  
  
  Systematic review of Ovid MEDLINE, PubMed, Cochrane databases, and EMBASE from inception to December 2015 for articles that included ruptured aneurysms treated with flow diversion.
  
  
  
  One hundred seventy-two records were screened, of which 20 articles contained sufficient patient and outcome data for inclusion.
  
  
  
  Clinical and radiologic characteristics, procedural details, and outcomes were extracted from these reports. Aggregated occlusion rates and clinical outcomes were analyzed by using the Fisher exact test (statistical significance, α = .05).
  
  
  
  Complete occlusion of the aneurysm was achieved in 90% of patients, and favorable clinical outcome was attained in 81%. Aneurysm size greater than 7 mm was associated with less favorable clinical outcomes (P= .027). Aneurysm size greater than 2 cm was associated with a greater risk of rerupture after treatment (P< .001).
  
  
  
  Observational studies and case reports may be affected by reporting bias.
  
  
  
  Although not recommended as a first-line treatment, the use of flow diverters to treat ruptured intracranial aneurysms may allow high rates of angiographic occlusion and good clinical outcome in carefully selected patients. Aneurysm size contributes to treatment risk because the rerupture rate following treatment is higher for aneurysms larger than 2 cm.
authors.affiliation: From the Mallinckrodt Institute of Radiology (T.P.M., C.J.M., D.T.C., A.P.K.) madaelilt@mir.wustl.edu.
authors.forename: T P
authors.identifier: 0000-0001-6900-8965
authors.initials: TP
authors.lastname: Madaelil
authors.affiliation: From the Mallinckrodt Institute of Radiology (T.P.M., C.J.M., D.T.C., A.P.K.).|Department of Neurosurgery (C.J.M., D.T.C., A.P.K.), Washington University School of Medicine, St. Louis, Missouri.
authors.forename: C J
authors.identifier: 0000-0001-5559-3390
authors.initials: CJ
authors.lastname: Moran
authors.affiliation: From the Mallinckrodt Institute of Radiology (T.P.M., C.J.M., D.T.C., A.P.K.).|Department of Neurosurgery (C.J.M., D.T.C., A.P.K.), Washington University School of Medicine, St. Louis, Missouri.
authors.forename: D T
authors.identifier: 0000-0001-8470-4897
authors.initials: DT
authors.lastname: Cross
authors.affiliation: From the Mallinckrodt Institute of Radiology (T.P.M., C.J.M., D.T.C., A.P.K.).|Department of Neurosurgery (C.J.M., D.T.C., A.P.K.), Washington University School of Medicine, St. Louis, Missouri.
authors.forename: A P
authors.identifier: 0000-0002-9201-4551
authors.initials: AP
authors.lastname: Kansagra
mesh_terms: D017542:Aneurysm, Ruptured / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome