Efficacy and safety of flow diverters for intracranial aneurysms: A meta-analysis

Abstract

Objective To evaluate the efficacy and safety of flow diverters (FDs) used for intracranial aneurysms. Methods A systematic search was conducted in PubMed, EBSCO and Web of Science for all accessible articles on FDs between January 2008 and December 2016. Two authors independently graded the quality of the studies and extracted the data. Meta-analysis was performed using the software of Stata. Results Fifty-three articles containing 4 458 patients with 4 973 aneurysms were included in the analysis. The overall rate of complete occlusion was 79% (95%CI: 75%-82%). The success rate of FD implantation was 97% (95%CI: 95%-99%). Overall mortality and morbidity were 2% (95%CI: 2%-3%) and 3% (95%CI: 3%-4%), respectively. The rate of intracranial hemorrhage, aneurysm rupture, intraparenchymal hematoma and ischemic stroke were 2% (95%CI: 1%-3%), 1% (95%CI: 0%-1%), 1% (95%CI: 1%-1%) and 4% (95%CI: 3%-5%), respectively. Stenosis of parent artery occurred in 5% (95%CI: 3%-7%) of the patients. The rate of parent artery occlusion was 2% (95%CI: 1%-4%). Subgroup analysis showed that the rates of mortality and morbidity were higher in Silk group (12%, 95%CI: 9%-15%) than those in Pipeline (4%, 95%CI: 3%-6%)and Surpass group(7%, 95%CI: 1%-17%). The rates of morbidity and mortality were higher for large or giant aneurysms. Conclusion FDs are suggested to be effective and relatively safe tools for treatment of intracranial aneurysms and, however, the complications should not be neglected. Key words: Intracranial aneurysm; Meta-analysis; Flow diverters; Efficacy; Safety